Volumetric stratification of cT4 stage head and neck cancer

G Studer,C Glanzmann

doi:10.1007/s00066-013-0413-3

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.

Highlights

Advanced stage head and neck cancer (HNC) is known for unfavorable outcome with only ~40–50% 3-year overall survival (OS)
We previously demonstrated that volumetric staging was superior compared to the standard TN/AJCC systems regarding predictive power of disease control and survival of our irradiated cohorts
The used staging system is based on three cut-offs (15/70/130 ml, see previous publications [4, 5, 6, 7]) to stratify the total gross tumor volumes, allowing a subdivision of cT4 stages into 4 prognostic subgroups [1– 15 ml (n=15), 16–70 ml (n=108), 71–130 ml (n=62), >130 ml (n=16)]

Summary

Introduction

Advanced stage head and neck cancer (HNC) is known for unfavorable outcome with only ~40–50% 3-year overall survival (OS). 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. Between 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. 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

Methods

Results

Conclusion