Tumor volumetry as a prognostic factor in the management of T4a laryngeal cancer

Objectives/Hypothesis The role of tumor volume in T4a laryngeal cancer remains unclear among different treatment modalities. Using tumor volumetry, we investigated the impact of primary tumor volume on this subset of patients. Study Design Retrospective cohort study of 62 T4a laryngeal cancer patients. Methods From October 2002 to September 2010, 48 patients were treated with definitive chemoradiation therapy (CRT), and 14 patients had undergone total laryngectomy. Tumor volume was calculated and was correlated with the overall survival (OS), progression-free survival (PFS), and local control rate (LCR) data of each treatment group. Results The 5-year OS, PFS, and LCR were significantly lower in the CRT group with tumor volume≥15 cm³ (22.5% vs. 48.7%, P=0.009; 32.2% vs. 64.3%, P=0.003; 45.2% vs. 67.3%, P=0.039). Multivariate analysis showed that tumor volume was an independent poor prognosticator for OS, PFS, and LCR in the CRT group. For tumor volume≥15 cm³, total laryngectomy provided a significantly higher 5-year OS and PFS (54.5% vs. 22.5%, P=0.039; 80.0% vs. 32.2%, P=0.017) than for those tumors treated with definitive CRT. Conclusions Patients with T4a laryngeal cancer with primary tumor volume≥15 cm³ had poorer survival outcomes after definitive CRT compared with total laryngectomy. It was also an independent poor prognosticator on LCR, PFS, and OS for those receiving definitive CRT. For patients with tumor volume≥15 cm³, total laryngectomy provided a better survival outcome than definitive CRT.