title: Computed tomography-based tumour volume as a predictor of outcome in laryngeal cancer: results of the phase 3 ARCON trial.
abstract: OBJECTIVE
  Retrospective studies indicate that larger tumour volume is a strong prognostic indicator for poor tumour control after (chemo)radiotherapy for laryngeal cancer. The impact of tumour volume on the outcome of patients treated within a prospective study comparing accelerated radiotherapy (AR)±carbogen breathing and nicotinamide (ARCON) was investigated.
  
  
  METHODS
  Of 345 patients with cT2-4 laryngeal cancer, pre-treatment computed tomography (CT) scans of 270 patients were available for tumour volume calculation. Contouring of the primary tumour and involved lymph nodes was reviewed by one experienced head and neck radiation oncologist. Kaplan-Meier plots were used for analysis of outcome.
  
  
  RESULTS
  Of 137 AR and 133 ARCON patients, 57 and 80 versus 56 and 77 patients had glottic and supraglottic tumours, respectively. A correlation between primary tumour volume and T-stage was observed (Rs=.51, P<.01). In both treatment arms no correlation was detected between the primary tumour volume and local control (LC), regional control (RC) and metastasis-free survival (MFS). A strong correlation between total nodal volume and N-stage was found (Rs=.93, P<.01). Both in the AR and ARCON groups total nodal volume was not associated with poorer RC rate. However, based on individual lymph node analyses, nodal control was in favour of ARCON, irrespective of volume (P<.01).
  
  
  CONCLUSIONS
  Neither primary tumour volume, nor total nodal volume is a prognostic factor for patients with cT2-4 laryngeal cancer treated with accelerated radiotherapy±carbogen breathing and nicotinamide. Additional analyses based on individual nodal volumes demonstrate an excellent regional control rate and a significant benefit of ARCON.
authors.affiliation: Dept. of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: g.janssens@rther.umcn.nl.
authors.forename: Geert O
authors.initials: GO
authors.lastname: Janssens
authors.affiliation: Dept. of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Liselotte W
authors.initials: LW
authors.lastname: van Bockel
authors.affiliation: Dept. of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Doornaert
authors.affiliation: Dept. of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hendrik P
authors.initials: HP
authors.lastname: Bijl
authors.affiliation: Dept. of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: van den Ende
authors.affiliation: Dept. of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Martin A
authors.initials: MA
authors.lastname: de Jong
authors.affiliation: Dept. of Oto-Rhino-Laryngology and Head & Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Guido B
authors.initials: GB
authors.lastname: van den Broek
authors.affiliation: Dept. of Radiology, Radboud University Nijmegen Medical Centre and Leiden University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Berit M
authors.initials: BM
authors.lastname: Verbist
authors.affiliation: Dept. of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Chris H
authors.initials: CH
authors.lastname: Terhaard
authors.affiliation: Dept. of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Span
authors.affiliation: Dept. of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Kaanders
mesh_terms: D002245:Carbon Dioxide / Q000008:administration & dosage / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000008:administration & dosage / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010100:Oxygen / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden / Q000187:drug effects / Q000528:radiation effects*
chemical_list: D011838:Radiation-Sensitizing Agents; D002245:Carbon Dioxide; D009536:Niacinamide; C011700:carbogen; D010100:Oxygen
keywords: ARCON; Laryngeal cancer; Lymph node volume; Randomised trial; Tumour volume