3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients

PurposeMany treatment approaches are available for head and neck cancer (HNC), leading to challenges for a multidisciplinary medical team in matching each patient with an appropriate regimen. In this effort, primary diagnostics and its reliable documentation are indispensable. A three-dimensional (3D) documentation system was developed and tested to determine its influence on interpretation of these data, especially for TNM classification.MethodsA total of 42 HNC patient data sets were available, including primary diagnostics such as panendoscopy, performed and evaluated by an experienced head and neck surgeon. In addition to the conventional panendoscopy form and report, a 3D representation was generated with the “Tumor Therapy Manager” (TTM) software. These cases were randomly re-evaluated by 11 experienced otolaryngologists from five hospitals, half with and half without the TTM data. The accuracy of tumor staging was assessed by pre–post comparison of the TNM classification.ResultsTNM staging showed no significant differences in tumor classification (T) with and without 3D from TTM. However, there was a significant decrease in standard deviation from 0.86 to 0.63 via TTM ($$p=0.027$$p=0.027). In nodal staging without TTM, the lymph nodes (N) were significantly underestimated with $$0.39\pm 0.79$$0.39±0.79 classes compared with $$0.07\pm 0.69$$0.07±0.69 with TTM ($$p=0.002$$p=0.002). Likewise, the standard deviation was reduced from 0.79 to 0.69 ($$p=0.032$$p=0.032). There was no influence of TTM results on the evaluation of distant metastases (M).ConclusionTNM staging was more reproducible and nodal staging more accurate when 3D documentation of HNC primary data was available to experienced otolaryngologists. The more precise assessment of the tumor classification with TTM should provide improved decision-making concerning therapy, especially within the interdisciplinary tumor board.

[1]  Bernhard Preim,et al.  TTM Tumor Therapy Manager , 2010, CURAC.

[2]  J. Olofsson,et al.  Multidisciplinary team a prerequisite in the management of head and neck cancer? , 2009, European Archives of Oto-Rhino-Laryngology.

[3]  A. Forastiere,et al.  Head and neck cancer: changing epidemiology, diagnosis, and treatment. , 2008, Mayo Clinic proceedings.

[4]  Russell H. Taylor,et al.  Information Processing in Computer-Assisted Interventions - Second International Conference, IPCAI 2011, Berlin, Germany, June 22, 2011. Proceedings , 2011, IPCAI.

[5]  Andreas Dietz,et al.  Current aspects of targeted therapy in head and neck tumors , 2008, European Archives of Oto-Rhino-Laryngology.

[6]  Bernhard Preim,et al.  Interactive Visualization for Neck-Dissection Planning , 2005, EuroVis.

[7]  Ashish Chandra,et al.  Integrated media presentation in multidisciplinary head and neck oncology meetings , 2009, European Archives of Oto-Rhino-Laryngology.

[8]  A. Dietz,et al.  Impact of indication-shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma , 2015, European Archives of Oto-Rhino-Laryngology.

[9]  Stefan Hentschel,et al.  Krebs in Deutschland 2009/2010 , 2013 .

[10]  L. Sobin,et al.  TNM Classification of Malignant Tumours , 1987, UICC International Union Against Cancer.

[11]  Bernhard Preim,et al.  The Tumor Therapy Manager - Design, Refinement and Clinical Use of a Software Product for ENT Surgery Planning and Documentation , 2011, IPCAI.

[12]  Jana Dornheim,et al.  Complete fully automatic model-based segmentation of normal and pathological lymph nodes in CT data , 2010, International Journal of Computer Assisted Radiology and Surgery.

[13]  Christian Munk,et al.  Trends in head and neck cancer incidence in Denmark, 1978–2007: Focus on human papillomavirus associated sites , 2011, International journal of cancer.

[14]  Bernhard Preim,et al.  Different approaches to volume assessment of lymph nodes in computer tomography scans of head and neck squamous cell carcinoma in comparison with a real gold standard , 2012, ANZ journal of surgery.

[15]  Paul Vos,et al.  Impact of Tumor Board Recommendations on Treatment Outcome for Locally Advanced Head and Neck Cancer , 2008, Oncology.

[16]  Leslie H. Sobin,et al.  Comprar TNM Classification of Malignant Tumours, 7th Edition | C. Wittekind | 9781444332414 | Wiley , 2009 .

[17]  K. Ang,et al.  Multidisciplinary management of locally advanced SCCHN: optimizing treatment outcomes. , 2008, The oncologist.