T3 喉癌基于放化疗的喉保留治疗中解剖侵犯的三维成像评估和容积学考虑因素。

Three-dimensional imaging assessment of anatomic invasion and volumetric considerations for chemo/radiotherapy-based laryngeal preservation in T3 larynx cancer.

机构信息

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

出版信息

Oral Oncol. 2018 Apr;79:1-8. doi: 10.1016/j.oraloncology.2018.01.025. Epub 2018 Feb 10.

DOI:10.1016/j.oraloncology.2018.01.025

PMID:29598944

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5880303/

Abstract

OBJECTIVES

To investigate the impact of 3-Diminsional (3D) tumor volume (TV) and extent of involvement of primary tumor on treatment outcomes in a large uniform cohort of T3 laryngeal carcinoma patients treated with nonsurgical laryngeal preservation strategies.

MATERIALS AND METHODS

The pretreatment contrast-enhanced computed tomography images of 90 patients with T3 laryngeal carcinoma were reviewed. Primary gross tumor volume (GTVp) was delineated to calculate the 3D TV and define the extent of invasion. Cartilage and soft tissue involvement was coded. The extent of invasion was dichotomized into non/limited invasion versus multiple invasion extension (MIE), and was subsequently correlated with survival outcomes.

RESULTS

The median TV was 6.6 cm. Sixty-five patients had non/limited invasion, and 25 had MIE. Median follow-up for surviving patients was 52 months. The 5-year local control and overall survival rates for the whole cohort were 88% and 68%, respectively. There was no correlation between TV and survival outcomes. However, patients with non/limited invasion had better 5-year local control (LC) than those with MIE (95% vs 72%, p = .009) but did not have a significantly higher rate of overall survival (OS) (74% vs 67%, p = .327). In multivariate correlates of LC, MIE maintained statistical significance whereas baseline airway status showed a statistically significance trend with poor LC (p = .0087 and 0.06, respectively). Baseline good performance status was an independent predictor of improved OS (p = .03) in multivariate analysis.

CONCLUSION

The extent of primary tumor invasion is an independent prognostic factor of LC of the disease after definitive radiotherapy in T3 larynx cancer.

摘要

目的

研究三维（3D）肿瘤体积（TV）和原发肿瘤受累程度对非手术保喉策略治疗的 T3 喉癌患者的治疗结果的影响。

材料与方法

回顾了 90 例 T3 喉癌患者的增强 CT 图像。描绘了原发肿瘤大体体积（GTVp）以计算 3D TV 并定义侵犯范围。编码软骨和软组织侵犯。侵犯程度分为非/局限性侵犯与多灶性侵犯（MIE），并与生存结果相关联。

结果

中位 TV 为 6.6cm。65 例患者为非/局限性侵犯，25 例为 MIE。存活患者的中位随访时间为 52 个月。全队列的 5 年局部控制率和总生存率分别为 88%和 68%。TV 与生存结果之间无相关性。然而，非/局限性侵犯患者的 5 年局部控制率（LC）优于 MIE 患者（95%比 72%，p=0.009），但总生存率（OS）无显著差异（74%比 67%，p=0.327）。在 LC 的多变量相关因素中，MIE 具有统计学意义，而基线气道状态显示出与较差 LC 的统计学意义趋势（p=0.0087 和 0.06）。基线良好的体能状态是多变量分析中 OS 改善的独立预测因素（p=0.03）。