title: Tumor volumetry as a prognostic factor in the management of T4a laryngeal cancer.
abstract: OBJECTIVE
  The role of tumor volume in T4a laryngeal cancer remains unclear among different treatment modalities. Using tumor volumetry, we investigated the impact of primary tumor volume on this subset of patients.
  
  
  METHODS
  Retrospective cohort study of 62 T4a laryngeal cancer patients.
  
  
  METHODS
  From October 2002 to September 2010, 48 patients were treated with definitive chemoradiation therapy (CRT), and 14 patients had undergone total laryngectomy. Tumor volume was calculated and was correlated with the overall survival (OS), progression-free survival (PFS), and local control rate (LCR) data of each treatment group.
  
  
  RESULTS
  The 5-year OS, PFS, and LCR were significantly lower in the CRT group with tumor volume ≥ 15 cm(3) (22.5% vs. 48.7%, P = 0.009; 32.2% vs. 64.3%, P = 0.003; 45.2% vs. 67.3%, P = 0.039). Multivariate analysis showed that tumor volume was an independent poor prognosticator for OS, PFS, and LCR in the CRT group. For tumor volume ≥ 15 cm(3) , total laryngectomy provided a significantly higher 5-year OS and PFS (54.5% vs. 22.5%, P = 0.039; 80.0% vs. 32.2%, P = 0.017) than for those tumors treated with definitive CRT.
  
  
  CONCLUSIONS
  Patients with T4a laryngeal cancer with primary tumor volume ≥ 15 cm(3) had poorer survival outcomes after definitive CRT compared with total laryngectomy. It was also an independent poor prognosticator on LCR, PFS, and OS for those receiving definitive CRT. For patients with tumor volume ≥ 15 cm(3), total laryngectomy provided a better survival outcome than definitive CRT.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Taoyuan, Taiwan.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Hsin
authors.forename: Tuan-Jen
authors.initials: TJ
authors.lastname: Fang
authors.forename: Ngan-Ming
authors.initials: NM
authors.lastname: Tsang
authors.forename: Shy-Chyi
authors.initials: SC
authors.lastname: Chin
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.forename: Hsueh-Yu
authors.initials: HY
authors.lastname: Li
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Liao
authors.forename: I-How
authors.initials: IH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007822:Laryngeal Neoplasms / Q000473:pathology* / Q000628:therapy*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: T4a laryngeal cancer; prognosticator; survival; tumor volume