Tumor volume predicts outcome for advanced head and neck cancer treated with targeted chemoradiotherapy.

OBJECTIVES/HYPOTHESIS: Just as tumor volume is a prognostic indicator for local disease control among patients with head and neck cancer of intermediate size treated with radiation therapy, we hypothesized a similar association for patients with advanced disease treated with chemoradiation therapy.

STUDY DESIGN: Retrospective analysis of primary and nodal tumor volume was correlated with prospectively collected treatment outcome measures.

METHODS: Sixty-four patients with stage III-IV disease who were treated with targeted intra-arterial chemotherapy and radiation therapy (RADPLAT) were studied. Tumor volume was correlated with local disease control and survival. RESULTS Primary tumor volume correlated with local disease control and survival. The greatest risk for local failure was found among patients with primary tumor volume greater than 19.6 cc (93.8% vs. 57% [P =.001]). A nominal logistic regression analysis demonstrated primary tumor volume as being the only significant parameter related to local failure. Survival was only 14.1% among patients with primary tumor volume greater than 19.6 cc compared with 41.5% for patients with volumes less than 19.6 cc ( P=.0018). A proportional hazard model indicated that the most significant and independent parameters associated with survival were primary tumor volume ( P=.0007) and the site of the tumor ( P=.05).

CONCLUSION: Tumor volume is the most important factor predictive of treatment outcome among patients with advanced head and neck cancer and should be used to stratify favorable versus unfavorable patient subsets.