Tumor volume as determined by computed tomography predicts local control in hypopharyngeal squamous cell carcinoma treated with primary surgery

Abstract

Computed tomography reliably evaluates hypopharyngeal squamous cell carcinomas (SCC) regarding the infiltration of specific anatomic structures and tumor volumes, both of which have been shown to be predictors of local control in patients treated with radiation therapy alone. However, an association of specific infiltrated structures and/or tumor volume with local control has not been investigated for surgical treatment; thus, we determined relationships of various infiltrated anatomic structures and tumor volume with local control in patients with hypopharyngeal SCC treated with primary surgery. In 45 hypopharyngeal SCC, tumor volumes were measured by pretreatment CT, and extent of tumor infiltration was determined by postoperative pathologic examination. All patients had clinical follow-up for recurrent tumor at the primary site. Statistical analysis basically consisted of chi-square and U-tests. Local control rate was 84.4% (38 of 45). Tumor volume was significantly associated with local control (p=0.004). Six of 16 (38%) patients with tumor volumes > or =8.1 cm3 (mean) had a local recurrence, which is significantly (p=0.003) more compared with 1 of 29 (3%) in the group of patients with volumes <8.1 cm3. Among all evaluated anatomic structures, only a tendency for significant association with local control was found for tumor involvement of the tonsils and the extralaryngeal soft tissues. The determination of tumor volumes by CT helps predict local control in patients with hypopharyngeal SCC treated with primary surgery.

Measurement by multidetector CT scan of the volume of hypopharyngeal and laryngeal tumours: accuracy and reproducibility

“…Thus the limits of agreement were slightly wider than those of the expert operator, and the geometrical mean of the histology vs. MDCT ratios was lower (0.86), though still close to 1. These data confirm the importance of experience in head and neck imaging [1][2][3]6]. As has already been stated by other authors [2,[4][5][6], knowledge of normal anatomy of this complex area and of the ways tumors spread is essential.…”

“…The risk of local recurrence increases in direct proportion to the increase in tumor volume in patients who are candidates for radiotherapy [28][29][30][31][32]. Recent publications have also confirmed this correlation in surgically treated tumors [1,2]. The therapeutic decision is influenced by several factors, such as tumor stage, presence or absence of regional or systemic diffusion, and the patient's general condition and choices [6].…”

“…Many authors have demonstrated the importance of tumor volume as an independent factor for determining the prognosis of laryngeal and hypopharyngeal tumors, and the correlation with laterocervical lymph-node metastases [28], sometimes even with a heavier clinical impact than Tstaging [1,2,[28][29][30][31][32]. The risk of local recurrence increases in direct proportion to the increase in tumor volume in patients who are candidates for radiotherapy [28][29][30][31][32].…”

“…The tumor stage is traditionally defined by TNM (UICC) classification, according to site, local extension of the disease, mobility of the vocal apparatus, and lymph node status. In clinical practice, however, there is no agreement among authors about the role of TNM as a prognostic factor, and whether it is adequate to predict the risk of local recurrence [1][2][3][4]; this is due to the technical difficulty of the clinical evaluation and the marked heterogeneity of these tumors.…”

“…The study of the prognostic factors of these tumors is open to clinical research, and the volume, together with the site of the neoplasm, are stronger predictive factors of local recurrence than TNM [1][2][3][4][5][6]. Neoplasm growth is exponential and depends on diameter, grade and proliferative index.…”