Clin Exp Otorhinolaryngol.  2009 Jun;2(2):78-84. 10.3342/ceo.2009.2.2.78.

Clinical Efficacy of Primary Tumor Volume Measurements: Comparison of Different Primary Sites

Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea. kyjung@kumc.or.kr
  • 2Department of Radiology, Korea University College of Medicine, Seoul, Korea.

Abstract


OBJECTIVES
The purpose of study was to determine the clinical efficacy of primary tumor volume measurements of different primary sites in the oropharynx compared to the oral cavity.
METHODS
A retrospective analysis of 85 patients with oral cavity or oropharynx cancer. The tumor area was manually outlined from axial magnetic resonance (MR) series. The software calculated the tumor volumes, automatically. The values of the primary tumor volumes were then subdivided into separate groups (< or =3,500 mm3, >3,500 mm3).
RESULTS
The prognostic indicators were the cT and cN (oral cavity); age, primary site, cT, cN, and primary tumor volume (oropharynx) on the univariate analysis. There was no significant prognostic factor for oral cavity cancer on the multivariate analysis. Primary site, cN, and primary tumor volume were independent prognostic indicators for oropharynx cancer by multivariate analysis.
CONCLUSION
Primary tumor volume measurement is a reliable way to stratify outcome, and make up for the weak points in the American Joint Committee on Cancer staging system with oropharynx cancer.

Keyword

Tumor volume; Prognosis; Lymphatic metastasis; Mouth neoplasm; Oropharyngeal neoplasm

MeSH Terms

Humans
Joints
Lymphatic Metastasis
Magnetic Resonance Spectroscopy
Mouth
Mouth Neoplasms
Multivariate Analysis
Neoplasm Staging
Oropharyngeal Neoplasms
Oropharynx
Prognosis
Retrospective Studies
Tumor Burden

Figure

  • Fig. 1 An example of measuring the primary tumor volume with using the 3D reconstruction program. (A) The gadolinium-enhanced, T1-weighted axial MR images of a tonsil cancer patient and (B) manual tracing of the area of the tumor. The tumor area is manually outlined (blue line) from the sequential sections. This allows the software to automatically calculate the areas of the lesions and, from the thickness of the slice, the volume of the tumor per slice and finally, the sum of the volumes of all the slices. (C) Pre-tracing the CT image of the same patient and (D) post-tracing the CT image.

  • Fig. 2 Distribution of the primary tumor volumes in the oral cavity (A) and the oropharynx (B). There was substantial variation of the primary tumor volume for the same stage lesions and a great deal of overlap among tumors at different stages, and especially those at the advanced stage. Therefore, the two-dimensional T stages do not reflect the actual three-dimensional tumor volume. We subdivided the patients into two volume groups based on the cutoff value of 3,500 mm3.

  • Fig. 3 Comparison of the survival plots between the patients with oropharynx and those with oral cavity cancers. (A) The Kaplan-Meier plot of the disease-free survival as assessed by the primary tumor volume and according to univariate analysis, P=0.009 (oropharynx cancer), (B) the overall survival as assessed by the primary tumor volume and according to univariate analysis, P=0.05 (oropharynx cancer), (C) multivariate study with Cox proportional hazard multivariate analysis, P=0.032 (oropharynx cancer) and (D) the Kaplan-Meier plot of the disease-free survival according to the primary tumor volume. As compared to the patients with oropharynx cancer, there was no significant relationship between the primary tumor volume and disease recurrence for the patients with oral cavity cancers (univariate test, P=0.147, oral cavity cancer).


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