Outcome Prediction After Surgery and Chemoradiation of Squamous Cell Carcinoma in the Oral Cavity, Oropharynx, and Hypopharynx: Use of Baseline Perfusion CT Microcirculatory Parameters vs. Tumor Volume

Bisdas, Sotirios; Nguyen, Shaun A.; Anand, Sharma K.; Glavina, Gordana; Day, Terry; Rumboldt, Zoran

doi:10.1016/j.ijrobp.2008.06.1956

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Volume 73, Issue 5 , Pages 1313-1318, 1 April 2009

Outcome Prediction After Surgery and Chemoradiation of Squamous Cell Carcinoma in the Oral Cavity, Oropharynx, and Hypopharynx: Use of Baseline Perfusion CT Microcirculatory Parameters vs. Tumor Volume

Sotirios Bisdas, M.D.
- Department of Radiology, Medical University of South Carolina, Charleston, SC
Shaun A. Nguyen, M.D., M.A.
- Department of Radiology, Medical University of South Carolina, Charleston, SC
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
Sharma K. Anand, M.D.
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
Gordana Glavina, M.D.
- Department of Radiology, Medical University of South Carolina, Charleston, SC
Terry Day, M.D.
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
Zoran Rumboldt, M.D.
- Department of Radiology, Medical University of South Carolina, Charleston, SC
- Reprint requests to: Zoran Rumboldt, MD, Department of Radiology, Medical University of South Carolina, 169 Ashley Avenue, SC, 29425. Tel: (843) 792-1573; Fax: (843) 792-1705

Received 22 February 2008; received in revised form 15 June 2008; accepted 23 June 2008. published online 28 October 2008.

Purpose

To assess whether pretreatment perfusion computed tomography (PCT) may predict outcome in chemoradiated patients with oral cavity, oropharynx, and hypopharynx squamous cell carcinoma (SCCA) after surgical excision.

Materials and Methods

Twenty-one patients with SCCA were examined before treatment. The primary site was oral cavity in 6, oropharynx in 7, and hypopharynx in 8 patients; there were 11 T2, 6 T3, and 4 T4 tumors. PCT was performed at the level of largest tumor diameter based on standard neck CT. The data were processed to obtain blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface area product (PS). Regions of interest were free-hand positioned on the lesions to obtain PCT measurements. Tumor volume was also calculated. Follow-up was performed with positron emission tomography (PET)/CT and endoscopy. Pearson correlation coefficient was used for comparison between the subgroups. A regression model was constructed to predict recurrence based on the following predictors: age, gender, tumor (T) and nodal (N) stage, tumor volume, and PCT parameters.

Results

BF_mean, BF_max, BV_mean, BV_max, MTT_mean, PS_mean, and PS_max were significantly different between patients with and without tumor recurrence (0.0001, p < 0.04). T stage, tumor volume, N stage, BF_max, BV_max, MTT_mean, and radiation dose (p < 0.001) were independent predictors for recurrence. Cox proportional hazards model for tumor recurrence revealed significantly increased risk with high tumor volume (p = 0.00001, relative risk [RR] 7.4), low PS_mean (p = 0.0001, RR 14.3), and low BF_max (p = 0.002, RR 5.9).