Prognostic impact of tumor volume in patients with stage III-IVA hypopharyngeal cancer without bulky lymph nodes treated with definitive concurrent chemoradiotherapy.

摘要

BACKGROUND: To investigate the prognostic value of volumetric analysis in patients with stage III-IVA hypopharyngeal cancer treated with concurrent chemoradiotherapy (CCRT). METHODS: Seventy-six stage III-IVA hypopharyngeal cancer patients without bulky lymph nodes were enrolled for a volumetric analysis. The pyriform sinus was the principal site of involvement in the 63 cases. All patients were allocated a course of CCRT. Tumor volume measurement was derived using separate calculations for the primary tumor volume (pGTV) and the nodal tumor volume (nGTV). RESULTS: The pGTV ranged from 3.8 to 152.4 mL (mean, 33.4 mL). The 3-year cause-specific survival (CSS) was 75% for those with a pGTV <30 mL and 20% when the pGTV was >or=30 mL (p = .0001). Furthermore, the 3-year primary tumor relapse-free survival (PRFS) was 72% for those with a pGTV <30 mL and 23% when the pGTV were >or=30 mL (p = .0001). The 3-year PRFSs for <30 mL and >or=30 mL were 74% and 25% for stage III disease (p = .01) and 65% and 22% for stage IVA tumors (p = .01), respectively. Multivariate analyses of the CSS revealed a single prognostic factor, namely pGTV <30 mL versus >or=30 mL (p = .0001, hazard ratio 2.84). Multivariate analyses of the PRFS gave a similar finding, with a pGTV >or=30 mL (p = .0001, hazard ratio 2.55) being significant. CONCLUSION: A patient's pGTV is a strong outcome predictor for hypopharyngeal cancer treatment using CCRT. Therefore, a selected group of patients, mainly those with tumor volumes <30 mL should be considered for laryngeal preservation.