Altered fractionation diminishes importance of tumor volume in oropharyngeal cancer: Subgroup analysis of ARTSCAN‐trial

Abstract INTRODUCTION Glioblastoma (GBM) is uniformly associated with a poor prognosis and inevitable recurrence. Management of recurrent GBM remains unclear, with repeat surgery often employed with varying degrees of success. We evaluated the efficacy of Laser Interstitial Thermal Therapy (LITT) for recurrent GBM when compared to a carefully matched cohort of patients treated with repeat surgical resection. METHODS A retrospective single-institution database was used to identify patients who underwent LITT or surgical resection of recurrent GBM between 2014-2019. LITT patients were matched with surgical resection patients according to baseline demographics, comorbidities, tumor location, and eloquence. Subgroup analysis matching similar patients for tumor volume was also completed. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. RESULTS A LITT cohort of 20 patients was matched to 50 similar patients who underwent repeat surgical resection. Baseline characteristics were similar between both cohorts apart from tumor volume, which was larger in the surgical cohort (17.5 cc vs. 4.7 cc, p< 0.01). On long-term follow-up, there was no difference in OS (HR, 0.72; 95%CI, 0.36-1.45) or PFS (HR, 0.67; 95%CI, 0.29-1.53) between the LITT and surgical cohorts when controlling for tumor volume. Subgroup analysis of 23 LITT patients matched according to tumor volume with 23 surgical patients with similar clinical characteristics also found no difference in OS (HR, 0.66; 95%CI, 0.33-1.30) or PFS (HR, 0.58; 95%CI, 0.90-1.05) between the cohorts. LITT patients had shorter length of stays (1 vs. 4 days, p< 0.001) and a higher rate of home discharge (84% vs. 67%, p=0.172) compared to the surgical cohort. CONCLUSION After matching for demographic, clinical, and tumor characteristics, there was no difference in outcomes between patients undergoing LITT compared to surgical resection for recurrent GBM. LITT patients had similar survival outcomes yet shorter hospital stays and more favorable dispositions, potentially mitigating post-treatment complications.

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The effect of induction chemotherapy on tumor volume and organ-at-risk doses in patients with locally advanced oropharyngeal cancer

Radiotherapy and Oncology ◽

10.1016/j.radonc.2013.07.016 ◽

2013 ◽

Vol 109 (2) ◽

pp. 269-274 ◽

Cited By ~ 3

Author(s):

Patricia Doornaert ◽

Max Dahele ◽

Wilko F.A.R. Verbakel ◽

Omar Bohoudi ◽

Ben J. Slotman ◽

...

Keyword(s):

At Risk ◽

Induction Chemotherapy ◽

Oropharyngeal Cancer ◽

Tumor Volume ◽

Locally Advanced ◽

Organ At Risk

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Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

Dysphagia ◽

10.1007/s00455-012-9394-0 ◽

2012 ◽

Vol 27 (4) ◽

pp. 481-490 ◽

Cited By ~ 35

Author(s):

Bena Cartmill ◽

Petrea Cornwell ◽

Elizabeth Ward ◽

Wendy Davidson ◽

Sandro Porceddu

Keyword(s):

Oropharyngeal Cancer ◽

Functional Outcomes ◽

Patient Perspective ◽

Altered Fractionation ◽

Concomitant Boost

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Outcomes of HPV-related oropharyngeal cancer patients treated by radiotherapy alone using altered fractionation

Radiotherapy and Oncology ◽

10.1016/j.radonc.2012.02.009 ◽

2012 ◽

Vol 103 (1) ◽

pp. 49-56 ◽

Cited By ~ 121

Author(s):

Brian O’Sullivan ◽

Shao Hui Huang ◽

Bayardo Perez-Ordonez ◽

Christine Massey ◽

Lillian L. Siu ◽

...

Keyword(s):

Cancer Patients ◽

Oropharyngeal Cancer ◽

Altered Fractionation ◽

Radiotherapy Alone

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Volumetric staging in radiotherapy for oropharyngeal cancers

Tumori Journal ◽

10.1177/03008916211050959 ◽

2021 ◽

pp. 030089162110509

Author(s):

Marcin Miszczyk ◽

Emilia Staniewska ◽

Iwona Jabłońska ◽

Aleksandra Lipka-Rajwa ◽

Konrad Stawiski ◽

...

Keyword(s):

Prognostic Factor ◽

Oropharyngeal Cancer ◽

Gross Tumor Volume ◽

Tumor Volume ◽

Stage Iv ◽

Staging System ◽

Tnm Staging ◽

Independent Prognostic Factor ◽

Tnm Staging System ◽

Volumetric Staging

Introduction: Despite routine use of 3D radiotherapy planning in radical radio(chemo)therapy for oropharyngeal cancers, volumetric data have not been implemented in initial staging. We analyzed 228 oropharyngeal cancer cases treated at one institution between 2004 and 2014 to compare the predictive value of volumetric staging and tumor nodal metastasis staging system (TNM) and determine whether they could be complementary for the estimation of survival. Methods: This retrospective study analyzed 228 consecutive oropharyngeal cancer cases treated with radiotherapy (76.9%) or concurrent radiochemotherapy (23.1%) between 2004 and 2014. The volumetric parameters included primary gross tumor volume (pGTV), metastatic lymph nodes gross tumor volume (nGTV), and total gross tumor volume (tGTV), and were compared with the 7th edition of the TNM staging system. Results: Median overall survival (OS) was 30.3 months. In the receiver operating characteristic analysis, tGTV had the highest area under the curve (AUC) of 0.66, followed by pGTV (AUC,0.64), nGTV (AUC 0.62), and TNM (AUC 0.6). The median OS for patients with tGTV ⩽32.2 mL was 40.5 months, compared to 15.4 months for >32.2 mL ( p < 0.001). This threshold allowed for a statistically significant difference in survival between TNM stage IV cases with low and high tumor volume ( p < 0.001). Despite both TNM and tGTV reaching statistical significance in univariate analysis, only the tGTV remained an independent prognostic factor in the multivariate analysis (hazard ratio 1.07, confidence interval 1.02–1.12, p = 0.008). Conclusions: tGTV is an independent prognostic factor, characterized by a higher discriminatory value than the TNM staging system, and can be used to further divide stage IV cases into subgroups with significantly different prognosis.

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