Value of computed tomography as outcome predictor of supraglottic squamous cell carcinoma treated by definitive radiation therapy

BACKGROUNDConcurrent chemoradiation is being used increasingly to treat patients with advanced‐stage head and neck carcinoma. In the current study, a clinical nomogram was developed to predict local control and overall survival rates for individual patients who will undergo chemoradiation.METHODSNinety‐two consecutive patients with UICC TNM Stage III/IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and supraglottic larynx were treated with selective‐targeted chemoradiation (acronym: RADPLAT). All living patients had a minimum follow‐up of 2 years. In addition to general factors, the following parameters were analyzed in a multivariable analysis: primary tumor volume, lymph node tumor volume, total tumor volume, lowest involved neck level, comorbidity, pretreatment hemoglobin level, pretreatment weight loss, and unilateral/bilateral intraarterial infusion. Relevant factors for local control and survival were analyzed using the Cox proportional hazards model.RESULTSAt 5 years, the local control and overall survival rates for the whole group were 60% and 38%, respectively. Primary tumor volume (hazard ratio [HR], 1.03; P = 0.01) and unilateral infusion (HR, 5.05; P = 0.004) were found to influence local control significantly. Using tumor volume as a continuous variable, an adjusted risk ratio of 1.026 was found, indicating that each 1‐cm3 increase in volume was associated with a 2.6% decrease in probability of local control. Primary tumor volume (HR, 1.01; P = 0.003), comorbidity (American Society of Anesthesiologists [ASA] physical status 1 vs. > 1; HR, 2.47; P = 0.01), lowest involved neck level (HR, 3.45; P = 0.007), and pretreatment weight loss > 10% (HR, 2.04; P = 0.02) were found to be significant predictors of worse overall survival. Variables from the multivariable analysis were used to develop a nomogram capable of predicting local control and overall survival.CONCLUSIONSTumor volume was found to play a significant role in predicting local control and overall survival in patients with advanced‐stage head and neck carcinoma who were treated with targeted chemoradiation. The nomograms may be useful for pretreatment selection of patients with advanced‐stage head and neck carcinoma. Cancer 2004. © 2004 American Cancer Society.

Section: Discussionmentioning

confidence: 99%

Pretreatment probability model for predicting outcome after intraarterial chemoradiation for advanced head and neck carcinoma

Broek

Rasch

Pameijer

et al. 2004

“…4 Numerous studies have shown that the macroscopic ("gross") tumor volume (GTV) at the primary site, as calculated from pretreatment computed tomography (CT) scans, can predict local control in squamous cell carcinoma (SCC) arising in different subsites of the head and neck in patients who are treated with definitive radiation therapy (RT). [5][6][7][8][9][10][11][12][13][14][15][16][17] Larger volume tumors have a higher likelihood of local recurrence than smaller volume lesions arising in the same anatomic subsite. [5][6][7][8][9][10][11][12][13][14][15][16][17] Threshold volumes have been identified in nasopharyngeal, oropharyngeal, supraglottic, pyriform sinus, and T3 glottic carcinomas.…”

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17] Larger volume tumors have a higher likelihood of local recurrence than smaller volume lesions arising in the same anatomic subsite. [5][6][7][8][9][10][11][12][13][14][15][16][17] Threshold volumes have been identified in nasopharyngeal, oropharyngeal, supraglottic, pyriform sinus, and T3 glottic carcinomas. [5][6][7][8][9][10][11][12][13][14][15][16][17] Several investigators also have shown that there is a stronger association between GTV and local control than the association between T classification and local control.…”

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17] Threshold volumes have been identified in nasopharyngeal, oropharyngeal, supraglottic, pyriform sinus, and T3 glottic carcinomas. [5][6][7][8][9][10][11][12][13][14][15][16][17] Several investigators also have shown that there is a stronger association between GTV and local control than the association between T classification and local control. 6,7,[15][16][17][18] This additional information helps physicians to counsel patients regarding the relative likelihood of local tumor control with primary surgery or RT with or without chemotherapy.…”

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confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17] Several investigators also have shown that there is a stronger association between GTV and local control than the association between T classification and local control. 6,7,[15][16][17][18] This additional information helps physicians to counsel patients regarding the relative likelihood of local tumor control with primary surgery or RT with or without chemotherapy. In regard to laryngeal carcinoma, information regarding the relative risk of local failure based on an objective, quantitative measure of GTV may assist patients in determining the risk they are willing to assume to preserve native laryngeal function.…”

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confidence: 99%

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Interobserver reliability of computed tomography‐derived primary tumor volume measurement in patients with supraglottic carcinoma

Mukherji¹,

Toledano²,

Beldon³

et al. 2005

Background: According to WHO 2008 guidelines, an important role is designated for cytoplasmic myeloperoxidase (cMPO) as measured by flow cytometry for classifying acute leukemia of myeloid or ambiguous origin (AML or MPAL). However, no threshold with respect to expression level and percentage positive cells is provided. Since the expression of solely cMPO can change the diagnosis from acute lymphoid leukemia into MPAL in the current WHO 2008, a consensus is needed for the cut‐off for cMPO. Methods: In this study, we investigated whether or not a cut‐off of 10% positivity for cMPO equally defines an acute leukemia as AML or MPAL as compared to a cut‐off for cMPO of 20% and compared this with results obtained for Sudan Black B (SBB) staining by cytomorphology. Results: Cell lineage‐defining markers and SBB staining were analyzed retrospectively in a cohort of 198 patients who presented with acute leukemia. Eight patients were positive for SBB (>3%), but were considered negative for cMPO (<10%); six patients were negative for SBB (≤3%) and positive for cMPO (≥10%) staining. In six patients, we found 10–20% cMPO positive leukemic cells. Five of these cases were SBB positive; the sixth patient showed a clear myeloid phenotype without positivity of any lymphoid marker. Using a 10% cut‐off instead of 20% would have changed diagnosis from ALL into MPAL in two patients; both cases were SBB positive by morphology. Conclusion: We conclude that a 10% cut‐off is a secure lower limit for cMPO expression and can be used independently from SBB expression. © 2013 International Clinical Cytometry Society

A higher radiotherapy dose is associated with more durable palliation and longer survival in patients with metastatic melanoma

Olivier

Schild

Morris

et al. 2007

Although Saccharomyces cerevisiae is capable of fermenting galactose into ethanol, ethanol yield and productivity from galactose are significantly lower than those from glucose. An inverse metabolic engineering approach was undertaken to improve ethanol yield and productivity from galactose in S. cerevisiae. A genome‐wide perturbation library was introduced into S. cerevisiae, and then fast galactose‐fermenting transformants were screened using three different enrichment methods. The characterization of genetic perturbations in the isolated transformants revealed three target genes whose overexpression elicited enhanced galactose utilization. One confirmatory (SEC53 coding for phosphomannomutase) and two novel targets (SNR84 coding for a small nuclear RNA and a truncated form of TUP1 coding for a general repressor of transcription) were identified as overexpression targets that potentially improve galactose fermentation. Beneficial effects of overexpression of SEC53 may be similar to the mechanisms exerted by overexpression of PGM2 coding for phosphoglucomutase. While the mechanism is largely unknown, overexpression of SNR84, improved both growth and ethanol production from galactose. The most remarkable improvement of galactose fermentation was achieved by overexpression of the truncated TUP1 (tTUP1) gene, resulting in unrivalled galactose fermentation capability, that is 250% higher in both galactose consumption rate and ethanol productivity compared to the control strain. Moreover, the overexpression of tTUP1 significantly shortened lag periods that occurs when substrate is changed from glucose to galactose. Based on these results we proposed a hypothesis that the mutant Tup1 without C‐terminal repression domain might bring in earlier and higher expression of GAL genes through partial alleviation of glucose repression. mRNA levels of GAL genes (GAL1, GAL4, and GAL80) indeed increased upon overexpression of tTUP. The results presented in this study illustrate that alteration of global regulatory networks through overexpression of the identified targets (SNR84 and tTUP1) is as effective as overexpression of a rate limiting metabolic gene (PGM2) in the galactose assimilation pathway for efficient galactose fermentation in S. cerevisiae. In addition, these results will be industrially useful in the biofuels area as galactose is one of the abundant sugars in marine plant biomass such as red seaweed as well as cheese whey and molasses. Biotechnol. Bioeng. 2011; 108:621–631. © 2010 Wiley Periodicals, Inc.