Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer.
OBJECTIVE
Tumor volume has been postulated to be an important prognostic factor for oncological outcome after radiotherapy or chemoradiotherapy. This postulate was retrospectively investigated in a consecutively treated cohort of T3-T4 larynx cancer patients.


METHODS
Retrospective cohort study.


METHODS
For 166 patients with T3-T4 larynx cancer (1999-2008), pretreatment computed tomography and magnetic resonance imaging scans were available for tumor volume delineation. Patients were treated with radiotherapy, chemoradiotherapy, or total laryngectomy with postoperative radiotherapy. Both a dedicated head and neck radiologist and the first author determined all tumor volumes. Statistical analysis was by Kaplan-Meier plots and Cox proportional hazard models.


RESULTS
Patients with T3 larynx cancer had significantly smaller tumor volumes than patients with T4 larynx cancer (median = 8.1 cm(3) and 15.8 cm(3), respectively; P < .0001). In the group treated with total laryngectomy and postoperative radiotherapy, no association was found between tumor volume and local or locoregional control or overall survival. In the group treated with radiotherapy, a nonsignificant trend was observed between local control and tumor volume. In the chemoradiotherapy group, however, a significant impact of tumor volume was found on local control (hazard ratio = 1.07; 95% confidence interval = 1.01-1.13; P = .028).


CONCLUSIONS
Tumor volume was not significantly associated with local control, locoregional control, or overall survival in the surgically treated group. In the group treated with radiotherapy, there was no statistically significant association, but a trend was observed between local control and tumor volume. Only in patients treated with concurrent chemoradiotherapy was a significant impact of tumor volume on local control found.


METHODS
4.
Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Adriana J
AJ
Timmermans
Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Charlotte A H
CA
Lange
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Josien A
JA
de Bois
Biometrics Department, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Erik
E
van Werkhoven
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Olga
O
Hamming-Vrieze
Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.|Institute of Phonetic Sciences/Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, the Netherlands.
Frans J M
FJ
Hilgers
Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands.|Institute of Phonetic Sciences/Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, the Netherlands.|Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Michiel W M
MW
van den Brekel
D000368:Aged; D001706:Biopsy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D047368:Tumor Burden
Head and neck cancer; imaging; larynx cancer; organ preservation; outcome; prognosis; total laryngectomy; tumor volume