Association of Primary Tumor Volume With Survival in Patients With T3 Glottic Cancer Treated With Radiotherapy-Reference-Cited by-同舟云学术

Association of Primary Tumor Volume With Survival in Patients With T3 Glottic Cancer Treated With Radiotherapy

Published:2023-02-01 Issue:2 Volume:149 Page:103
ISSN:2168-6181
Container-title:JAMA Otolaryngology–Head & Neck Surgery
language:en
Short-container-title:JAMA Otolaryngol Head Neck Surg

Author:

Malik Nauman H.¹²,Fu Rui³,Hainc Nicolin⁴⁵,Noel Christopher W.³,de Almeida John R.⁶,Hosni Ali²,Hui Huang Shao²,Yu Eugene⁵,Dzioba Agnieszka⁷,Leung Andrew⁸⁹,Mangat Arvindpaul⁸⁹,MacNeil Danielle⁷,Nichols Anthony C.⁷,Hiremath Shivaprakash B.⁸⁹,Chakraborty Santanu⁸⁹,Jooya Alboorz¹⁰,Gaudet Marc¹⁰,Johnson-Obaseki Stephanie¹¹,Whelan Jonathan¹¹,Forghani Reza¹²¹³,Hier Michael P.¹²,Morand Grégoire¹²,Sultanem Khalil¹⁴,Dort Joseph¹⁵,Lysack John¹⁶,Matthews Wayne¹⁵,Nakoneshny Steven¹⁵,Gill Gia¹⁷,Globerman Adam¹⁸,Kerr Paul¹⁷,Maralani Pejman⁵,Karam Irene¹,Eskander Antoine³

Affiliation:

1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

2. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada

3. Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

4. Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland

5. Department of Medical Imaging, University of Toronto, Toronto, Canada

6. Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada

7. Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada

8. Department of Radiology, Western University, London, Ontario, Canada

9. Department of Medical Imaging, Western University, London, Ontario, Canada

10. Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

11. Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada

12. Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada

13. Department of Radiology, University of Florida College of Medicine, Gainesville

14. Department of Oncology, McGill University, Jewish General Hospital, Montréal, Québec, Canada

15. Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada

16. Section of Neuroradiology, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

17. Department of Otolaryngology-Head & Neck Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

18. Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

Abstract

ImportanceThe association of primary tumor volume with outcomes in T3 glottic cancers treated with radiotherapy with concurrent chemotherapy remains unclear, with some evidence suggesting worse locoregional control in larger tumors.ObjectiveTo evaluate the association of primary tumor volume with oncologic outcomes in patients with T3 N0-N3 M0 glottic cancer treated with primary (chemo)radiotherapy in a large multi-institutional study.Design, Setting, and ParticipantsThis multi-institutional retrospective cohort study involved 7 Canadian cancer centers from 2002 to 2018. Tumor volume was measured by expert neuroradiologists on diagnostic imaging. Clinical and outcome data were extracted from electronic medical records. Overall survival (OS) and disease-free survival (DFS) outcomes were assessed with marginal Cox regression. Laryngectomy-free survival (LFS) was modeled as a secondary analysis. Patients diagnosed with cT3 N0-N3 M0 glottic cancers from 2002 to 2018 and treated with curative intent intensity-modulated radiotherapy (IMRT) with or without chemotherapy. Overall, 319 patients met study inclusion criteria.ExposuresTumor volume as measured on diagnostic imaging by expert neuroradiologists.Main Outcomes and MeasuresPrimary outcomes were OS and DFS; LFS was assessed as a secondary analysis, and late toxic effects as an exploratory analysis determined before start of the study.ResultsThe mean (SD) age of participants was 66 (12) years and 279 (88%) were men. Overall, 268 patients (84%) had N0 disease, and 150 (47%) received concurrent systemic therapy. The mean (SD) tumor volume was 4.04 (3.92) cm3. With a mean (SD) follow-up of 3.85 (3.04) years, there were 91 (29%) local, 35 (11%) regional, and 38 (12%) distant failures. Increasing tumor volume (per 1-cm3 increase) was associated with significantly worse adjusted OS (hazard ratio [HR], 1.07; 95% CI, 1.03-1.11) and DFS (HR, 1.04; 95% CI, 1.01-1.07). A total of 62 patients (19%) underwent laryngectomies with 54 (87%) of these within 800 days after treatment. Concurrent systemic therapy was associated with improved LFS (subdistribution HR, 0.63; 95% CI, 0.53-0.76).Conclusions and RelevanceIncreasing tumor volumes in cT3 glottic cancers was associated with worse OS and DFS, and systemic therapy was associated with improved LFS. In absence of randomized clinical trial evidence, patients with poor pretreatment laryngeal function or those ineligible for systemic therapy may be considered for primary surgical resection with postoperative radiotherapy.

Publisher

American Medical Association (AMA)

Subject

Otorhinolaryngology,Surgery

Link

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/2799128/jamaotolaryngology_malik_2022_oi_220082_1675893416.55414.pdf

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