Clinical Applications of Tumor Volume Measurements for Predicting Outcome in Patients with Squamous Cell Carcinoma of the Upper Aerodigestive Tract
Suresh K. Mukherjia,
Ilona M. Schmalfussb,
Jonas Castelijnsc and
Anthony A. Mancusob
a Departments of Radiology and Otolaryngology Head Neck Surgery, University of Michigan Health Systems, Ann Arbor, Gainesville, FL
b the Department of Radiology, University of Florida School of Medicine, Gainesville, FL
c the Department of Radiology, Free University, Amsterdam, the Netherlands
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FIG 1. Technique of volume contouring.
A, Axial enhanced CT scan obtained at the level of the cricoarytenoid joint shows a true vocal cord carcinoma on the left. A white contour has been drawn around the tumor.
B, Axial CT scan obtained at the aryepiglottic fold shows transglottic spread of the tumor (white contour). This finding precludes voice-conservation laryngectomy (hemilaryngectomy).
C, Tumor (white contour) also extends inferior to the level of the subglottis, preventing partial laryngectomy (supracricoid laryngectomy). The only surgical alternative was total laryngectomy. Total tumor volume was 3.2 mL. The patient was treated with combined chemotherapy and RT.
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FIG 2. Patient with an 8.4-mL supraglottic carcinoma. Pre-RT enhanced CT scan obtained at the lower supraglottic level shows a mass (arrow) infiltrating the paraglottic space on the left. Despite the large tumor volume, the patient elected definitive RT, which failed. The patient then underwent successful salvage resection of the supraglottic larynx (supraglottic laryngectomy).
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FIG 3. Pre-RT enhanced CT scans at the level of the true vocal cords in a patient with a T3 glottic carcinoma and sclerosis of the arytenoid and cricoid cartilages on the left. Calculated tumor volume was 4.3 mL. The patient elected curative RT alone, though the likelihood of control was <20% based on the CT risk profile. Because of the high risk of recurrence, close post-treatment surveillance with CT was chosen. Treatment failed, and total laryngectomy was performed.
A, Soft tissue window shows cancer of the true vocal cords on the left (arrow) without involvement of the anterior commissure (arrowhead).
B, Bone window shows sclerosis of the left lingual cortex of the left lamina of the thyroid cartilage (arrowhead) and the left arytenoid cartilage (arrow).
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FIG 4. Patient with a 4.5-mL cancer of the right pyriform sinus with minimal involvement of its apex. The patient was cured with RT alone.
A, Pretreatment enhanced CT scan through the lower third of the sinus shows a large mass (arrow) predominantly along the anterior and lateral walls of the sinus on the right.
B, Axial image at the level of the true vocal cords shows minimal involvement of the apex of the sinus on the involved side. Compare the mildly enhancing fullness of the apex on the right with normally enhancing mucosa on the left (arrows). Note subtle obliteration of the submucosal fat plane on the right compared with the left (arrowheads).
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