CT-Based Evaluation of Tumor Volume After Intra-Arterial Chemotherapy of Locally Advanced Carcinoma of the Oral Cavity: Comparison with Clinical Remission Rates

PurposeTo assess the volume of locally advanced tumors of the oral cavity and the oropharynx before and after intra-arterial (i.a.) chemotherapy by means of computed tomography and to compare these data with clinically determined treatment response of the same patient population.MethodsEighty-eight patients with histologically proven, advanced carcinoma of the oral cavity and/or the oropharynx (local tumor stages T3/4) received neoadjuvant i.a. chemotherapy with cisplatin as part of a multimodal therapeutic regimen, comprising (1) local chemotherapy, (2) surgery, and (3) combined radio-chemotherapy. Three weeks after the intervention, residual disease was evaluated radiologically by measurement of the tumor volume and clinically by inspection and palpation of the primary tumor according to WHO criteria.ResultsComparison of treatment response according to radiological and clinical criteria respectively revealed complete remission in 5% vs. 8% (p < 0.05), partial remission in 30% vs. 31%, stable disease in 61% vs. 58%, and tumor progression in 5% vs. 2%.ConclusionRadiological volumetry and clinical evaluation found comparable response rates after local chemotherapy. However, in patients with good response after local treatment, volumetric measurement with CT may help to distinguish between partial and complete remission. Thus, radiological tumor volumetry provides precise and differentiated information about tumor response and should be used as an additional tool in treatment monitoring after local chemotherapy.

[1]  N. Tunçbilek,et al.  Dynamic contrast enhanced MRI in the differential diagnosis of soft tissue tumors. , 2005, European journal of radiology.

[2]  A. Krajina,et al.  Selective intraarterial chemotherapy of tumors in the lingual artery territory by a new approach , 1993, CardioVascular and Interventional Radiology.

[3]  G. Calais,et al.  Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  G. Shah,et al.  Magnetic Resonance Spectroscopy of Head and Neck Neoplasms , 2004, Topics in magnetic resonance imaging : TMRI.

[5]  K. Robbins,et al.  Targeted chemoradiation for advanced head and neck cancer: Analysis of 213 patients , 2000, Head & neck.

[6]  L. Zijp,et al.  Pretreatment probability model for predicting outcome after intraarterial chemoradiation for advanced head and neck carcinoma , 2004, Cancer.

[7]  E Bellon,et al.  Factors influencing the accuracy of volume measurements in spiral CT: a phantom study. , 1997, Journal of computer assisted tomography.

[8]  M Van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. , 2000, Journal of the National Cancer Institute.

[9]  R. D. Hunter,et al.  WHO Handbook for Reporting Results of Cancer Treatment , 1980 .

[10]  Ralph S. Greco,et al.  Three dimensional staging of breast cancer , 2005, Breast Cancer Research and Treatment.

[11]  H. Sakahara,et al.  Continuous selective intraarterial chemotherapy in combination with irradiation for locally advanced cancer of the tongue and tongue base. , 2002, Oral oncology.

[12]  M Kono,et al.  Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. , 1997, Radiology.

[13]  M. van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors , 2000, Journal of the National Cancer Institute.

[14]  Carlo Catalano,et al.  T staging of gastric cancer: role of multi-detector row CT. , 2005, Radiology.

[15]  S. Toma,et al.  Intraarterial chemotherapy through carotid transposition in advanced head and neck cancer , 1990, Cancer.

[16]  J. Pauly,et al.  Feasibility study of lactate imaging of head and neck tumors , 1998, NMR in biomedicine.

[17]  Tuan-Kay Lim,et al.  Tongue carcinoma: tumor volume measurement. , 2004, International journal of radiation oncology, biology, physics.

[18]  A. Kovács.  Intraarterial chemotherapy and chemoembolization in head and neck cancer. Establishment as a neoadjuvant routine method , 2003 .

[19]  B. Turowski,et al.  Intraarterial chemotherapy as neoadjuvant treatment of oral cancer. , 1999, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[20]  P. Validire,et al.  Induction chemotherapy in advanced head and neck tumors: results of two randomized trials. , 1992, International journal of radiation oncology, biology, physics.

[21]  E J Topol,et al.  Comparison of the ABC/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the GUSTO-1 trial. , 1998, Stroke.

[22]  D. Disler,et al.  Accuracy of Volume Measurements of Computed Tomography and Magnetic Resonance Imaging Phantoms by Three-Dimensional Reconstruction and Preliminary Clinical Application , 1994, Investigative radiology.

[23]  Edna Schechtman,et al.  Magnetic resonance imaging reveals functional diversity of the vasculature in benign and malignant breast lesions , 2005, Cancer.

[24]  B. Fisher,et al.  Low-grade gliomas in children: tumor volume response to radiation. , 1998, Neurosurgical focus.

[25]  W. Regine,et al.  Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: the Memphis experience. , 1997, International journal of radiation oncology, biology, physics.

[26]  K. Robbins.  The evolving role of combined modality therapy in head and neck cancer. , 2000, Archives of otolaryngology--head & neck surgery.

[27]  B. Turowski,et al.  Combined modality treatment of oral and oropharyngeal cancer including neoadjuvant intraarterial cisplatin and radical surgery followed by concurrent radiation and chemotherapy with weekly docetaxel - three year results of a pilot study. , 2002, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[28]  S. Ehara,et al.  Superselective continuous arterial infusion chemotherapy through the superficial temporal artery for oral cavity tumors. , 2000, AJNR. American journal of neuroradiology.

[29]  A. Kovács.  Intra-arterial induction high-dose chemotherapy with cisplatin for oral and oropharyngeal cancer: long-term results , 2004, British Journal of Cancer.

[30]  George Fountzilas,et al.  Usefulness of Tumor Volumetry as a Prognostic Factor of Survival in Head and Neck Cancer , 2003, Strahlentherapie und Onkologie.

[31]  T. Mori,et al.  Superselective cisplatin (CDDP)-carboplatin (CBDCA) combined infusion for head and neck cancers. , 1995, European journal of radiology.

[32]  F. Kainberger,et al.  Neoadjuvant radiochemotherapy of oral cavity and oropharyngeal cancer: evaluation of tumor response by ct differs from histopathologic response assessment in a significant fraction of patients , 2004, Head & neck.

[33]  A. Kovács,et al.  Long-Term Complete Remission of Oral Cancer after Anti-Neoplastic Chemotherapy as Single Treatment Modality: Role of Local Chemotherapy , 2002, Journal of chemotherapy.

[34]  B. Turowski,et al.  Combined modality treatment of oral and oropharyngeal cancer including neoadjuvant intraarterial cisplatin and radical surgery followed by concurrent radiation and chemotherapy with weekly docebaxel – three year results of a pilot study , 2002 .