Tumor Volume Useful Beyond Classic Criteria in Selecting Larynx Cancers For Preservation Therapy
- 13 November 2019
- journal article
- research article
- Published by Wiley in The Laryngoscope
- Vol. 130 (10), 2372-2377
- https://doi.org/10.1002/lary.28396
Abstract
Objective To investigate the association between tumor volume and locoregional failure (LRF) after concurrent chemoradiation (CCRT) for locally advanced larynx cancer (LC). Methods This is a retrospective cohort study from 2009 to 2014 identified from an institutional review board–approved registry. Fifty‐nine of 68 patients with locally advanced larynx cancer treated with definitive CCRT who had available imaging for review were identified. The main endpoint to be assessed was the association between gross tumor volumes (GTV; T = total, P = primary, N = nodal) and LRF. Receiver operative characteristic (ROC) curves were used to investigate diagnostic accuracy. Results Twenty LRFs were observed, resulting in a 2‐year LRF rate of 39% (95% CI, 23–52%). On UVA, the GTV‐T (P = .01), GTV‐P (P = .05), and GTV‐N (P = .04) were statistically significant predictors of LRF. Furthermore, age, smoking status, N‐stage, larynx subsite, and tracheostomy/feeding tube dependence were potentially associated with LRF (P < .3), whereas T‐stage (T3–4 vs. T2) was not (HR 1.05, 95% CI, 0.38–2.91, P = .92). In the multivariable model, GTV‐P (HR 1.022, 95% CI, 0.999–1.046, P = .07) and GTV‐N (HR 1.053, 95% CI, 1.0004–1.108, P = .05) were the two most impactful covariates on the model's R2. ROC analysis suggested an optimal cut point of 12 cc in the GTV‐T. The 2‐year LRF for GTV‐T > 12 cc was 64.2% and ≤ 12 cc was 16.4%, P = .006. Conclusion GTV is associated with LRF after definitive CCRT for LC. Patients with bulky primary and/or nodal tumors may be better served with upfront surgical resection regardless of T‐stage. Further investigation into the safety of larynx preservation for low‐volume T4 tumors can be considered. Level of Evidence 4 Laryngoscope, 2019Keywords
This publication has 20 references indexed in Scilit:
- Salvage Laryngectomy in Patients with Recurrent Laryngeal Cancer in the Setting of Nonoperative Treatment FailureOtolaryngology -- Head and Neck Surgery, 2013
- Primary Tumor Volume Is an Important Predictor of Clinical Outcomes Among Patients With Locally Advanced Squamous Cell Cancer of the Head and Neck Treated With Definitive ChemoradiotherapyEndocrine, 2012
- The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNMAnnals of Surgical Oncology, 2010
- Multidisciplinary Management of Laryngeal CarcinomaEndocrine, 2007
- T3 and T4 True Vocal Cord Squamous Carcinomas Treated With External Beam IrradiationAmerican Journal of Clinical Oncology, 2007
- Laryngeal Cancer in the United States: Changes in Demographics, Patterns of Care, and SurvivalThe Laryngoscope, 2006
- Prognostic impact of tumor volumetry in patients with locally advanced head-and-neck carcinoma (non-nasopharyngeal) treated by radiotherapy alone or combined radiochemotherapy in a randomized trialEndocrine, 2004
- Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy?Endocrine, 1997
- The EORTC randomized trial on three fractions per day and misonidazole in advanced head and neck cancer: prognostic factorsRadiotherapy and Oncology, 1995
- Induction Chemotherapy plus Radiation Compared with Surgery plus Radiation in Patients with Advanced Laryngeal CancerThe New England Journal of Medicine, 1991