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• W2104440123 abstract "Tumor volume is the most important single prognostic factor in patients treated with radiotherapy for head and neck cancers. We have investigated the impact of volume as well as presence of visible necrosis with special emphasis on the influence of therapy. 51 patients with locally advanced (T3-4 or N2-3) squamous cell cancers of the head&neck (mean age 57 years, range 41–75y) were entered in a protocol investigating the impact of tumor volume. Clinical stage distribution was: 2 T1-2, 7 T3, 42 T4, 7 N0-1, 33 N2, 11 N3. All patients received CT-examination of the head and neck according to a standardized protocol (spiral CT, contrast enhancement after automatic injection). The total tumor volume was calculated as the sum of volumes of all visible macroscopic tumor sites (primary and nodes). Poorly perfused and necrotic areas (no contrast enhancement) within macroscopic tumor sites were also calculated. Patients were treated according to standard regimens with accelerated-hyperfractionated radiotherapy (5x 2Gy up to 30Gy followed by twice daily 1.4Gy up to a total dose of 77.6Gy in about 5.5 -6 weeks). 17 pats. were treated with radiation alone (plus mitomycin C in 4 of them). Patients without contraindications to cisplatin chemotherapy received either cisplatin alone (N = 11) or (in case of large tumors) cisplatin plus paclitaxel in a phase-II-protocol (N = 23). The median follow-up in survivors was 18 months (range 4–57 months). The mean total tumor volume was 64.3 + 54.4ccm (median 45.8 ccm), the necrotic/poorly perfused volume was 12.0 + 17.0ccm (median 3.7 ccm), and the well-perfused tumor volume (total tumor volume minus necrotic/poorly perfused volume) was 46.7 + 37.1ccm (median 37.2ccm). 26 patients developed either a local recurrence (N = 14) or distant metastases (N = 8) or both (N = 4). The event-free survival was 46% after 2 years and the 2-year overall survival was 55%. In patients treated with radiation without cisplatin, 12/17 (71%) pats. recurred. Patients with recurrence had a higher tumor volume and a significantly higher poorly perfused volume. In patients treated with radiation plus cisplatin, 14/34 (41%) recurred (p = 0.048 vs. pats. with radiation alone). Tumor volume and poorly perfused volume were not different in patients with recurrence versus controlled patients (table 1). The well-perfused volume was not different in patients with/without recurrence irrespective of type of therapy. An impact of tumor volume as risk factor for failure was identified only in patients treated with radiation alone and not in patients treated with additional cisplatin ± paclitaxel. Moreover, the impact of volume mainly resulted from the poorly perfused (hypoxic ?) tumor volume whereas the well-perfused (better oxygenated ?) volume had no impact on recurrence rate. Patients with small or well-perfused tumors have a low risk for local and systemic failures after radiation alone and probably do not benefit from aggressive chemoradiation protocols." @default.
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• W2104440123 date "2004-09-01" @default.
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• W2104440123 title "Tumor volume is a predictive factor in patients treated with radiotherapy but not in patients treated with radiochemotherapy" @default.
• W2104440123 doi "https://doi.org/10.1016/j.ijrobp.2004.07.442" @default.
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