PROGNOSTIC IMPACT OF TUMOR VOLUME IN PATIENTS WITH STAGE III-IVA HYPOPHARYNGEAL CANCER WITHOUT BULKY LYMPH NODES TREATED WITH DEFINITIVE CONCURRENT CHEMORADIOTHERAPY

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 >= 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 >= 30 mL (p = .0001). The 3-year PRFSs for < 30 mL and >= 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 >= 30 mL (p = .0001, hazard ratio 2.84). Multivariate analyses of the PRFS gave a similar finding, with a pGTV >= 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. (c) 2009 Wiley Periodicals, Inc. Head Neck 31: 709-716, 2009