CT findings at the primary site of oropharyngeal squamous cell carcinoma within 6–8 weeks after definitive radiotherapy as predictors of primary site control (original) (raw)
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American Journal of Neuroradiology
To determine whether pretreatment CT can predict local control of T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy alone. METHODS: Pretreatment CT studies were retrospectively evaluated by two head and neck radiologists in 28 patients with T2 squamous cell carcinoma of the glottic larynx treated with definitive radiation therapy. All patients were followed for a minimum of 2 years. A tumor score was calculated based on the CT findings of tumor involvement of the following areas: the anterior commissure, the contralateral true vocal cord, the arytenoid face, the interarytenoid region, the laryngeal ventricle, the paraglottic space at the true and false vocal cord levels, and the subglottic region. Tumor volumes based on pretreatment CT were measured in each patient using a computer digitizer. Statistical analysis was performed using the independent sample t test, Wilcoxon's rank sum test, and Fisher's Exact Test. RESULTS: There was no statistically significant relationship between tumor volume or tumor score and outcome of the T2 glottic tumors treated with definitive radiation therapy in this series. The overall local control rate was 82%. There were no treatment complications that resulted in loss of laryngeal function. CONCLUSIONS: Like low-volume supraglottic and T3 glottic carcinomas, T2 glottic squamous cell carcinoma is likely (82%) to be controlled with definitive radiation therapy. Failure to control the primary tumor is attributable to factors other than volume, which may not be detectable on CT, such as tumor-host biological factors. Pretreatment CT, however, is beneficial for detecting submucosal spread across the ventricle and subglottic extension, which might contraindicate vertical hemilaryngectomy and might not be apparent on endoscopic examination.
Quantitative analysis from CT is prognostic for local control of supraglottic carcinoma
Head & Neck, 2001
Background. The purpose of this study was to determine whether pretreatment imaging with CT was prognostic for control of the primary site in patients with squamous cell carcinoma of the supraglottic larynx. Methods. Pretreatment CT studies were obtained on 28 patients treated definitively with radiation therapy for supraglottic larynx cancer between 1991 and 1997. Follow-up ranged from 20À58 months. Results. Local control was achieved in 61% of patients. Tumor volumes ranged from 0À68.6 cm 3 , with a median of 3.1 cm 3. Local control rates for tumors with volumes greater than or less than 8 cm 3 were 20% and 70%, respectively (p = .0077). Mean tumor volumes for patients with and without recurrences were 10 cm 3 and 3.4 cm 3 , respectively. Conclusions. This study demonstrates that quantitative analysis from CT imaging is prognostic for control of the primary site when radiation therapy is given for treatment of supraglottic cancer.
International Journal of Radiation Oncology*Biology*Physics, 1997
Purpose: To determine if pretreatment computed tomography (CT) can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy (RT). Methods and Materials: Forty-two patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with RT alone; all had a minimum 2-year follow-up. Tumor volumes and extent were determined by consensus of two head and neck radiologists on pretreatment CT studies. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. Sclerosis of any laryngeal cartilage was recorded. The specific CT parameters assessed were correlated with local control. Results: Tumor volume was a significant predictor of local control. For tumors measuring < 3.5 cm3, local control was achieved in 22 of 26 patients (85%), whereas for tumors 2 3.5 cm3, local control was achieved in 4 of 16 patients (25%) (p = 0.0002). Sensitivity and specificity using this cutpoint were 85% and 75%, respectively. Tumor score as a measure of anatomic extent was also found to be a significant predictor of local control. The local control rate for tumors assigned a low tumor score (I 5) was 78% (21 of 27) compared to 33% (5 of 15) for tumors assigned a high tumor score (6,7, or 8) (p = 0.008). A signlflcant decrease in the local control rate was observed for cancers involving the paraglottic space at the false vocal cord level 16 [sS%] vs. 12/26 [46%]) (p = O.OlO), cancers involving the face of the arytenoid (15 of 18 [83%] vs. 11 of 24 [46%]) (p = 0.024), and tumors involving the interarytenoid region (25 of 36 [69%] vs. 1 of 6 [17%]; p = 0.020). There were 12
International Journal of Radiation Oncology*Biology*Physics, 1993
Purpose: To determine if pretreatment computed tomography findings can predict local control in T3 squamous zinoma of the glottic larynx treated with radiotherapy alone. Methods and Materials: Twenty-nine patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with radiotherapy alone; all had a minimum 2-year follow-up. Highquality pretreatment computed tomography scans were retrospectively reviewed by a single head and neck radiologist for tumor involvement of various anatomic subsites within the larynx, and total tumor volumes were calculated for 18 of the most recent patients using a computer digitizer. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. Results: A significant decrease in the local control rate was observed for cancers involving the face of the arytenoid (11 of 20 [55%] vs. 9 of 9 [loo%]; p = .02), or the paraglottic space at the false vocal cord level (7 of 16 (44%] vs. 13 of 13 [loo%]; p # < .Ol). Tumors assigned a high tumor score (6, 7, or 8) had a significantly decreased rate of local control with radiation therapy when compared with tumors assigned a low tumor score (I 5): 1 of 7 (14%) vs. 19 of 22 (86%) (p = .Ol). Total tumor volume also significantly correlated with the rate of tumor control. For tumors measuring 3.5 cm3 or less, local control was achieved in 11 of 12 patients (92%), whereas for tumors greater than 3.5 cm', local control was achieved in 2 of 6 patients (33%) (p = .02). Conclusion: Pretreatment computed tomography scans can contribute significantly to the treatment decision for patients with T3 glottic carcinoma and can define a subset of patients with an excellent chance of being cured with preservation of a functional larynx after treatment with radiotherapy alone.
Role of Multidetector CT in Evaluation of Neck Lesions
Journal of Evidence Based Medicine and Healthcare
AIMS AND OBJECTIVES To find out the role of multidetector computed tomography in the evaluation of neck lesions with respect to evaluation of the size, location and extent of tumour. Extension of tumour infiltrating into surrounding vascular and visceral structures. To correlate the findings of MD-CT with final diagnosis by biopsy. MATERIAL AND METHODS Data for the study was collected from patients with suspected neck lesions attending Department of Radio-diagnosis, J.L.N. Medical College and Associated Group of Hospitals, Ajmer, Rajasthan. A prospective study was conducted over a period (From 1st March 2014 to 31 Aug. 2015) on patients with clinically suspected neck lesions or patients who were diagnosed to have neck lesion on ultrasound and were referred to CT for further characterisation. The patients presented with symptoms of palpable neck mass and neck pain. Patients were evaluated using multidetector CT. A provisional diagnosis was made after CT scan and these findings were correlated with histopathology/surgical findings as applicable. RESULT In the present study, 97 out of 100 cases were correctly characterised by computed tomography giving an accuracy of 97%. One case of buccal carcinoma was wrongly diagnosed as benign lesion and another case of malignant lymph node was inaccurately diagnosed as benign lymph node, also another case of benign lymph node was inaccurately diagnosed as malignant lymph node. CONCLUSION Multidetector Computed Tomography of the neck has improved the localisation and characterisation of neck lesions. Accurate delineation of disease by CT scan provides a reliable preoperative diagnosis, plan for radiotherapy ports and posttreatment followup. However, histopathology still remains the gold standard as CT is not 100% accurate.
International Journal of Radiation Oncology*Biology*Physics, 1999
Purpose: To determine if pre-radiotherapy (RT) and/or post-radiotherapy computed tomography (CT) can predict local failure in patients with laryngeal carcinoma treated with definitive RT. Methods and Materials: The pre-and post-RT CT examinations of 59 patients (T3 glottic carcinoma [n ؍ 30] and T1-T4 supraglottic carcinoma [n ؍ 29]) were reviewed. For each patient, the first post-RT CT study between 1 and 6 months after irradiation was used. All patients were treated with definitive hyperfractionated twice-daily continuous-course irradiation to a total dose of 6,720 -7,920 cGy, and followed-up clinically for at least 2 years after completion of RT. Local control was defined as absence of primary tumor recurrence and a functioning larynx. On the pre-treatment CT study, each tumor was assigned a high-or low-risk profile for local failure after RT. The post-RT CT examinations were evaluated for post-treatment changes using a three-point post-RT CT-score: 1 ؍ expected post-RT changes; 2 ؍ focal mass with a maximal diameter of < 1 cm and/or asymmetric obliteration of laryngeal tissue planes; 3 ؍ focal mass with a maximal diameter of > 1 cm, or < 50% estimated tumor volume reduction. Results: The local control rates at 2 years post-RT based on pre-treatment CT evaluation were 88% for low pre-treatment risk profile patients (95% CI: 66 -96%) and 34% (95% CI: 19 -50%) for high pre-treatment risk profile patients (risk ratio 6.583; 95% CI: 2.265-9.129; p ؍ 0.0001). Based on post-treatment CT, the local control rates at 2 years post-RT were 94% for score 1, 67% for score 2, and 10% for score 3 (risk ratio 4.760; 95% CI: 2.278 -9.950 p ؍ 0.0001). Post-RT CT scores added significant information to the pre-treatment risk profiles on prognosis. Conclusions: Pre-treatment CT risk profiles, as well as post-RT CT evaluation can identify patients, irradiated for laryngeal carcinomas, at high risk for developing local failure. When the post-RT CT score is available, it proves to be an even better prognosticator than the pre-treatment CT-risk profile.
European Journal of Nuclear Medicine and Molecular Imaging, 2015
Purpose The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). Methods We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/ dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. Results Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient man
International Journal of Radiation Oncology*Biology*Physics, 2006
Purpose: Our aim was to report the control rate of radiographically positive retropharyngeal (RP) nodes with radiation therapy (RT) and to correlate posttreatment imaging with clinical outcome. Methods and Materials: Sixteen patients treated with definitive RT for head-and-neck cancer had radiographically positive RP nodes (size >1 cm in largest axial dimension, or presence of focal enhancement, lucency, or calcification), and both pre-RT and post-RT image sets available for review. An additional 21 patients with unconfirmed radiographically positive RP nodes had post-RT imaging, which consisted of computed tomography (CT) at a median of 4 weeks after completing RT. Patients with positive post-RT RP nodes underwent observation with serial imaging. Results: Of 16 patients with pre-RT and post-RT images available for review, 9 (56%) had a radiographic complete response, and of 21 patients with unconfirmed positive RP nodes with post-RT images available for review, 14 (67%) had a radiographic complete response. In all, 14 patients with incomplete response on post-RT imaging experienced control of their disease with no further therapy, and no RP node or neck failures were noted during a median follow-up of 2.8 years. Six patients with positive post-RT RP nodes had serial imaging available for review, and none demonstrated radiographic progression of disease. Conclusions: Radiographic response at 4 weeks may not accurately reflect long-term locoregional control, as RP nodes may continue to resolve over time. The highest index of suspicion should be reserved for patients with progressive changes in size, focal lucency, or focal enhancement on serial imaging after RT.