title: Prognostic impact of tumor volume in patients with stage III-IVA hypopharyngeal cancer without bulky lymph nodes treated with definitive concurrent chemoradiotherapy.
abstract: BACKGROUND
  To investigate the prognostic value of volumetric analysis in patients with stage III-IVA hypopharyngeal cancer treated with concurrent chemoradiotherapy (CCRT).
  
  
  METHODS
  Seventy-six stage III-IVA hypopharyngeal cancer patients without bulky lymph nodes were enrolled for a volumetric analysis. The pyriform sinus was the principal site of involvement in the 63 cases. All patients were allocated a course of CCRT. Tumor volume measurement was derived using separate calculations for the primary tumor volume (pGTV) and the nodal tumor volume (nGTV).
  
  
  RESULTS
  The pGTV ranged from 3.8 to 152.4 mL (mean, 33.4 mL). The 3-year cause-specific survival (CSS) was 75% for those with a pGTV <30 mL and 20% when the pGTV was >or=30 mL (p = .0001). Furthermore, the 3-year primary tumor relapse-free survival (PRFS) was 72% for those with a pGTV <30 mL and 23% when the pGTV were >or=30 mL (p = .0001). The 3-year PRFSs for <30 mL and >or=30 mL were 74% and 25% for stage III disease (p = .01) and 65% and 22% for stage IVA tumors (p = .01), respectively. Multivariate analyses of the CSS revealed a single prognostic factor, namely pGTV <30 mL versus >or=30 mL (p = .0001, hazard ratio 2.84). Multivariate analyses of the PRFS gave a similar finding, with a pGTV >or=30 mL (p = .0001, hazard ratio 2.55) being significant.
  
  
  CONCLUSIONS
  A patient's pGTV is a strong outcome predictor for hypopharyngeal cancer treatment using CCRT. Therefore, a selected group of patients, mainly those with tumor volumes <30 mL should be considered for laryngeal preservation.
authors.affiliation: Department of Radiation Oncology, Taipei Medical University, Municipal Wan Fang Hospital, Taipei, Taiwan. vincent1680616@yahoo.com.tw
authors.forename: Shang-Wen
authors.initials: SW
authors.lastname: Chen
authors.forename: Shih-Neng
authors.initials: SN
authors.lastname: Yang
authors.forename: Ji-An
authors.initials: JA
authors.lastname: Liang
authors.forename: Fang-Jen
authors.initials: FJ
authors.lastname: Lin
authors.forename: Ming-Hsui
authors.initials: MH
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects