Volumetric stratification of cT4 stage head and neck cancer

Abstract

BackgroundLocoregionally advanced stage head and neck cancer (HNC) is known for unfavorable outcome with only ~ 40–50 % 3-year overall survival (OS). Clinical T4 stage includes a wide range of tumor burden. The lack of further nonsurgical subgrouping of cT4 stage makes intercenter outcome of irradiated cohorts difficult. Aim of this analysis was to further stratify cT4 stage HNC using volumetric staging.Material and methodsBetween January 2002 and January 2013, a total of 201 cT4 stage squamous cell cancer (SCC) HNC patients referred to our center for curative definitive radiation were consecutively irradiated. Radiation was performed using modulated techniques. Total gross tumor volumes (tGTV: primary + nodal tumor volume) of all patients have retrospectively been stratified using a prospectively evaluated volumetric staging system which bases on 3 cut-offs (15/70/130 ml), translating into 4 prognostic subgroups [V1: 1–15 ml (n = 15), V2: 16–70 ml (108), V3: 71–130 ml (62), V4: > 130 ml (16)]. OS, disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) rates were calculated.ResultsThe mean/median follow-up was 31/23 months (range 1–116 months). The 3-year OS, DFS, LRC, and DMFS rates of the entire cohort were 63, 44, 48, and 77 %, respectively. Volumetric staging revealed its potential to prognostically statistically significantly divide the cT4 cohort into 4 volume subgroups (V1/2/3/4): OS: 90 %/72 %/58 %/18 %; DFS: 83 %/50 %/39 %/10 %; LRC: 81 %/53 %/47 %/15 %; DMFS: 93 %/90 %/70 %/41 %, all p < 0.0001.ConclusionVolumetric staging allowed a highly statistically significant stratification of cT4 HNC stages into prognostic subgroups, which offers the chance of better intercenter comparability of irradiated advanced stage HNC cohorts.

Comparison of contemporary staging systems for oropharynx cancer in a surgically treated multi‐institutional cohort

“…This may be a result of either a type I error, or an unconventional hypothesis‐generating finding worth to be investigated further: The incidence of ECE+ is correlated with lymph node size . Another fact is the prognostic impact of volumetric burden of the disease . Therefore, it is possible that the volumetric nodal burden of the disease actually plays a more important role than the “true” pECE, and ECE is a rather surrogate marker for nodal volume, and not necessarily vice versa.…”

“…42 Another fact is the prognostic impact of volumetric burden of the disease. 43,44 Therefore, it is possible that the volumetric nodal burden of the disease actually plays a more important role than the "true" pECE, and ECE is a rather surrogate marker for nodal volume, and not necessarily vice versa.…”

Tumor volume as an independent predictive factor of worse survival in patients with oral cavity squamous cell carcinoma

“…This is a simple and easy way to obtain information, which has not been properly evaluated in operated tumors. Previous studies have suggested that tumor volume should be incorporated into staging systems …”

“…Previous studies have suggested that tumor volume should be incorporated into staging systems. [64][65][66][67] The value used as a cutoff for volume measurement stratification was 33.6 cc. Hypothetically, a lesion measuring 3.9 cm 3 3.5 cm 3 2.5 cm would fulfill this criterion.…”

Utilization and incorporation of tumor volume data in staging and prognostication of head and neck squamous cell carcinoma treated with definitive radiotherapy: A systematic review

“…Studer and Glanzmann [50] retrospectively studied 201 with T4-stage head and neck cancer patients and stratified them using volumetric staging system based on three cut-offs of TTV 15, 70, and 130cc, thus creating 4 subgroups for prognostic purpose. The subgroups were V1-V4: 1-15 ml (n = 15), 16-70 ml (n = 108), 71-130 ml (n = 62), >130 ml (n = 16).…”