Deep Spread Patterns in CT Staging of T_2–4 Squamous Cell Laryngeal Carcinoma

Abstract

In addition to clinical examination and less sophisticated radiographic techniques, high-resolution computerized tomography (CT) can help to stage squamous cell carcinoma of the larynx. This study was undertaken to identify findings on CT scans that might predict the likelihood of radiation therapy (RT) alone, controlling the primary site disease without significant irradiation-related complications. Of 30 patients with T2-4 cancers of the larynx, 13 were classified as favorable and 17 were classified as unfavorable candidates for RT based on the CT criteria of transglottic spread, more than 25% pre-epiglottic space involvement, extensive paralaryngeal space spread, or cartilage involvement. Seven of 17 (41%) unfavorable patients had local recurrences, two are alive with cancer, three patients are dead of disease (DOD), and five had significant complication, but there was no evidence of recurrent cancer. In the favorable group, there were two local recurrences (15%), one distant metastasis, one patient is DOD, and one had a significant complication, but no recurrent cancer. These data may be used to more adequately select and inform patients with T2-4 squamous cell carcinoma of the larynx before RT.

Overstaging of cartilage invasion by multidetector CT scan for laryngeal cancer and its potential effect on the use of organ preservation with chemoradiation

“…Controversy exists regarding the association between CT-depicted cartilage involvement in laryngeal carcinoma and poor outcomes after radiation therapy for locally advanced head and neck cancer [13,14]. Although clinical evidence of cartilage involvement has historically been considered a contraindication for organ preservation with radiation therapy, more recent studies have suggested that cartilage abnormalities on CT or MRI are not an independent predictor of local failure [15][16][17][18].…”

Approaches to Preserve Larynx Function in Locally Advanced Laryngeal and Hypopharyngeal Cancer

“…The selection of patients with advanced (T3, T4) resectable laryngeal cancers for definitive radiotherapy based on favorable prognostic characteristics has resulted in reports with local control rates comparable to those reported in surgical series [25][26][27]. Unfavorable characteristics for definitive radiotherapy include soft tissue invasion [28], cartilage invasion [25,28,29], the need for tracheotomy [25,30,31], extension into the hypopharynx [32], extensive involvement of the preepiglottic space [26,33], infiltrative rather than exophytic growth [34][35][36][37], extension into the oropharynx, and base of tongue involvement [26]. Most of these characteristics directly reflect the tumor volume.…”

Function-preserving Treatment in Laryngeal Cancer

“…Contrary to the data of Harwood [31], Castelijns et al [5] observed a local failure rate of 63% in patients with signs of cartilage invasion by magnetic reso nance tomography (60% in Tl/2!). Freeman et al [17] and Isaacs et al [35] analyzed the computerized tomographies of patients irradiated for T2-4 supraglottic cancers and found a local control rate of 82% for a tumor volume of <6 cm3 versus 55% in tumors of >6 cm3. An additional unfavorable sign was deep infiltration of the base of the tongue.…”