Computed tomography evaluation after induction chemotherapy for T3 laryngeal cancer: Does response correlate with vocal cord mobility?

• Published in: Oral oncology 2019-03, Vol.90, p.13-16
• Main Authors: Garcia, Gabriel C.T.E., Gorphe, Philippe, Hartl, Dana, Ammari, Samy, Even, Caroline, Tao, Yungan, Balleyguier, Corinne, Varoquaux, Arthur, Bidault, François
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Area Under Curve; Biochemistry, Molecular Biology; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Computed tomography; Data Accuracy; Female; Humans; Induction Chemotherapy; Laryngeal carcinoma; Laryngeal Neoplasms - diagnostic imaging; Laryngeal Neoplasms - drug therapy; Laryngeal Neoplasms - pathology; Life Sciences; Male; Middle Aged; Neoplasm Staging; RECIST1.1; Reproducibility of Results; Retrospective Studies; ROC Curve; Tomography, X-Ray Computed; Treatment Outcome; Tumor Burden - drug effects; Vocal cord remobilization; Vocal Cords - diagnostic imaging; Volume evaluation; WHO criteria
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2019.01.009

•RECIST1.1, WHO and volumetric methods on CT match with vocal cord remobilization.•WHO criteria on CT are as accurate, very reproducible but easier to use than volume.•WHO criteria could be used after induction chemotherapy for T3 laryngeal cancer. After induction chemotherapy (IC) for laryngeal cancer, Computed Tomography (CT) is used to assess tumor response but lacks rationalized methods for measurement of this response. In T3 laryngeal cancer, remobilization of an initially fixed vocal cord (VC) is a major sign of tumor response. We compared the performances of RECIST1.1, WHO and volumetric methods of evaluating response with laryngeal remobilization to determine if these measurements could objectively assess tumor response. This monocentric retrospective cohort study included patients treated with T3 laryngeal cancer with initial VC fixation treated with an organ preservation protocol with IC between 1999 and 2012. Tumors were measured with CT using RECIST1.1, WHO and volumetric methods by two radiologists blinded to VC remobilization (VCR), before and after induction chemotherapy and VC mobility was clinically assessed. Radiologic tumor shrinkage was compared to VCR. AUCs of ROC curves were compared. Inter-reader reliability, sensitivity and specificity of optimal cutoffs were determined. Seven females and thirty-six males with a mean age of 59 years were included. AUCs were 0.759, [95%CI 0.614; 0.904] for RECIST1.1, 0.763, [95%CI 0.617; 0.909] for WHO and 0.752, [95%CI 0.608; 0.896] for volumetric evaluations with no significant difference among the three techniques. Inter-reader reader reliabilities were good (RECIST1.1) to excellent (WHO and volumetric methods). RECIST1.1, WHO and volumetric measures match with VCR after IC in patient with T3 laryngeal cancer. WHO criteria combine accuracy, reproducibility and practical use; they may be best adapted for response assessment and protocol design.