Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT

Studer, Gabriela; Lütolf, Urs M.; El-Bassiouni, Mazen; Rousson, Valentin; Glanzmann, Christoph

doi:10.1080/02841860600815407

Cited by 97 publications

(121 citation statements)

References 22 publications

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“…As far as we know, the here presented study is the first attempt to use a VSS with defined predictive cut off values for DM prediction. The tested VSS has been reported as a highly reliable tool to predict local-regional outcome [28], and could herewith been confirmed as similarly reliable in predicting DM (Figure 2). …”

Section: Discussionmentioning

confidence: 58%

“…In 16%, no chemotherapy was added, mainly due to co-morbidity or age. In 22 patients (5%), concomitant ; n total = 172, in this recent study included), a volumetric staging system (VSS) was found the most important predictor of local-regional outcome [28]. This VSS bases on two cut-offs: primary or total gross tumor volume (GTV): 1-15 cc (favourable) vs. 16-70 cc (intermediate) vs. > 70 cc (unfavourable).…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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Background and Purpose: Intensity modulated radiation therapy (IMRT) combined treatment approaches, surgical and radiodiagnostic advances, respectively, lead to improved local-regional control in head neck cancer (HNC). With increasing local-regional control, distant metastases (DM) become more meaningful. In some trials without concomitant chemotherapy, induction chemotherapy (IC) resulted in an absolute reduction of DM by ~10-15%. In order to define a more efficient selection of patients at risk for DM with respect to IC and M-staging, we analysed our patients treated by contemporary standards. Patients and Methods: Between 1/2002 to 12/2007, 409 HNC patients were treated with IMRT; 303/409 (74%) underwent definitive, 106 (26%) postoperative IMRT. The mean/median follow-up was 23/20 months (3-72). 70% tolerated 4-7, 9% 1-3 cycles of simultaneous cisplatin. Treatment followed a prospectively designed protocol. In a previous study with 172 HNC IMRT patients, gross tumor volume (GTV) was found the strongest predictor for local-regional control. In the current study, this criterion has been prospectively tested for DM. Numbers needed to treat were calculated for IC. Results: DM developed in 28/399 (7%) patients; 10 presented initially with DM (total 38/409). In 13/28 (46%), DM remained the only manifestation of disease. GTV was the strongest predictor for DM (p < 0.0001) of all tested. Only 4% of patients with GTV < 70 cc developed DM, vs. 25% (18/73) with > 70 cc; only 6 of them (6/73, 8%) developed isolated DM. Conclusion: GTV was the most significant predictor for DM, that could guide selective pre-treatment M-staging. The subgroup with isolated DM in the high risk group, that could benefit from IC, is small. (Table 1). Die Therapie folgte einem prospektiv festgelegten Protokoll. In einer früheren Studie mit 172 KHTPatienten mit definitiver IMRT wurde das "gross tumor volume" (GTV) als signifikantester Prädiktor für die Lokoregionalkontrolle nachgewiesen. In der hier präsentierten Studie wurde dasselbe volumetrische Staging-System getestet hinsichtlich dessen prä-diktiven Wert für DM, um eine allfällige IC wie auch die initiale Metastasensuche selektiver auf ein Hochrisikopatientensegment beschränken zu können. Ergebnisse: DM fanden sich bei 38/409 Patienten bzw. bei 28/399 mit initialem M0-Status (7%) (Abbildung 1, Tabelle 2); 10 Patienten hatten initial bereits DM. Bei nur 13/28 (46%) blieben DM die einzige Krankheitsmanifestation. Das GTV erwies sich als signifikantester aller getesteter Metastasenprädiktoren (p < 0,0001, Abbildung 2, Tabelle 3); nur 4% der Patienten mit einem GTV < 70 cc entwickelten DM, vs. 25% (18/73) mit GTV > 70 cc, von diesen nur 6 mit isolierter DM (6/73, 8%). IntroductionClinical implementation of intensity modulated radiation therapy (IMRT), together with combined treatment approaches in definitive and postoperative treatment settings, surgical and radio-diagnostic advances, respectively, lead to an encouraging improvement of the loco-regional control in head and neck cancer (HNC)...

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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“…42,43 Gross tumor volume is also correlated with worse outcome for head and neck cancer patients receiving cetuximab with radiation. 30 We hypothesized that increasing tumor size may decrease the responsiveness of tumors to cetuximab. Our data did not support this hypothesis, however, since even greater than 10-fold increases in tumor volume did not seem to affect response to cetuximab in the HNSCC cell line xenografts (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Increases in gross tumor volume have been shown to decrease response to cetuximab in HNSCC patients, 30 so we hypothesized that increasing tumor volumes concurrently with decreasing the starting dose of cetuximab may permit the selection of cetuximab resistant cells. We generated six xenografts using UM-22B cells, and we did not begin treatment of the animals until the median tumor volume exceeded 50 mm 3 ( Fig.…”

Section: Hnscc Cell Lines Have a Narrow Range Of Sensitivity To Erlotmentioning

confidence: 99%

Preclinical modeling of EGFR inhibitor resistance in head and neck cancer

Quesnelle¹,

Wheeler²,

Ratay³

et al. 2012

Cancer Biology & Therapy

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“…T V has been shown to be of prognostic value in head and neck malignancies [10,11,[21][22][23][24][25][26]. Chong et al [27] recently validated a semi-automated method for measuring the T V of lingual carcinomas on T 2 weighted MRI images.…”

Section: Discussionmentioning

confidence: 99%

Evaluating lingual carcinoma for surgical management: what does volumetric measurement with MRI offer?

Boland

Watt-Smith²,

Pataridis³

et al. 2010

BJR

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ABSTRACT. MRI plays a crucial but under utilized role in the surgical management of lingual squamous cell carcinoma (SCC). Measurement of three-dimensional tumour volume (TV) has the potential to guide management of clinically negative cervical lymph nodes and address deficiencies in current TNM staging criteria. This work studied the value of MRI-measured TV as a predictor of 2 year disease-related survival (DRS) and disease-free survival (DFS), as well as occult cervical lymph node metastasis (OM) in lingual cancer. TV was determined by manually segmenting the tumour contour in each image slice and using the resulting pixel value to calculate the three-dimensional extent of disease. TV was also compared with the more established measure of tumour thickness (TT). Significant differences in DRS (x 2 (1) 5 7.7, Hazard ratio (HR) 5 7.3, p 5 0.005) and DFS (x 2 (1) 5 5.6, HR 5 4.3, p 5 0.02) at two years were found using a cut-off of 8 cm 3 . Similarly, a significant relationship between TV and occult cervical lymph node metastasis was discovered using a 3 cm 3 cut-off (OR 5 6.7, p 5 0.02, Fisher's Exact Test).

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Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT

Cited by 97 publications

References 22 publications

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Preclinical modeling of EGFR inhibitor resistance in head and neck cancer

Evaluating lingual carcinoma for surgical management: what does volumetric measurement with MRI offer?

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