The Laryngoscope Lippincott Williams & Wilkins, Inc. © 2006 The American Laryngological, Rhinological and Otological Society, Inc. Value of Computed Tomography-Based Tumor Volume as a Predictor of Outcomes in Hypopharyngeal Cancer After Treatment With Definitive Radiotherapy Shang-Wen Chen, MD; Shih-Neng Yang, MD; Ji-An Liang, MD; Ming-Hsiu Tsai, MD; An-Cheng Shiau, MS; Fang-Jen Lin, MD, PhD Objectives: To investigate the value of pretreat- ment computed tomography (CT) volumetric analysis for the prediction of treatment outcome in patients with hypopharyngeal cancer (HPC) treated by defin- itive radiotherapy (RT). Methods: From January 2000 through February 2004, 63 patients with HPC were enrolled for a retrospective analysis. The pyriform sinus was the principle site of involvement in 62 cases. All patients received with 1.8 Gy daily to a total dose of 68.4 to 73.8 Gy (median, 70.2 Gy). Contrast- enhanced CT images were transferred to a planning system. Tumor volume measurement was derived from summation of the primary and metastatic nodal tumor. Results: With a median follow-up of 38 (range, 24 – 68) months, the 5 year local relapse-free survival (LRFS) was 83% for patients with T1 to T2 disease, 46% for those with T3 disease, and 40% for those with T4 disease (P  .01). The 5 year LRFS was 75% for those with tumors less than 40 mL and 26% when volumes were 40 mL of larger (P  .0001). For patients with T3 to T4 disease, the 5 year LRFS was 70% for those with tumors less than 40 mL and 24% when volumes were 40 mL or larger (P  .0005). Multivari- ate analyses of local relapse-free survival revealed two prognostic factors: tumor volume more than 40 mL and the involvement of the larynx. Conclusions: CT-based tumor volumes are a strong predictor of outcomes for HPC treated using definitive RT. A se- lected group of patients, mainly those with tumor vol- umes less than 40 mL, should be considered for laryn- geal preservation. Key Words: Hypopharyngeal cancer, radiotherapy, tumor volume, prognostic factor. Laryngoscope, 116:2012–2017, 2006 INTRODUCTION The treatment of choice for hypopharyngeal cancer (HPC) varies among institutions. Radiotherapy (RT) al- lows preservation of laryngeal function, and the selection criteria for RT are similar and have been based primarily on the analogue for laryngeal cancer. Traditionally, pa- tients with T1 and T2 HPC can be treated with RT for laryngeal preservation. In contrast, T3 or T4 lesions are considered unfavorable for RT, and there is considerable controversy regarding the optimum treatment method. Total laryngectomy, combined with neck lymph node dis- section, is often recommended in these patients. 1 Curative RT with surgical salvage in reserve is also an accepted protocol. Overall, results of salvage surgery after RT fail- ure have been unsatisfactory. 2–4 A significant number of RT failures may not be salvaged with surgery either be- cause of the late diagnosis or the patient’s refusal to un- dergo subsequent surgery. Nevertheless, in patients who are anatomically unsuitable or medically unfit for sur- gery, definitive RT with or without chemotherapy is al- ways suggested. However, the survival and local control rate for advanced HPC has been shown to be inferior to that for the analogue of laryngeal cancer. 1 For optimiza- tion of treatment outcomes and larynx preservation schema, there is a need for better selection of patients with advanced tumors; in this way, a more informed treat- ment choice can be made. Some concerns have been raised about the weakness of the TNM-classification for head and neck cancer. 5,6 Current methods to define tumor volume are usually not precisely quantitative. 6 The adverse effect of increasing tumor burden on local control using RT is an important concept. Thus, outcome variations among studies may be From the Department of Radiation Therapy and Oncology (S.-W.C., S.-N.Y., J.-A.L., A.-C.S., F.-J.L.), China Medical University Hospital, Taichung, Taiwan, the Department of Otorhinolarygology (M.-H.T.), China Medical University Hospital, Taichung, Taiwan, and the School of Medicine (S.-W.C., S.-N.Y., J.-A.L., M.-H.T., A.-C.S., F.-J.L.), China Medical University, Taichung, Taiwan. Editor’s Note: This Manuscript was accepted for publication July 11, 2006. Address correspondence to Shang-Wen Chen, Department of Radia- tion Therapy and Oncology, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, Taiwan 404. E-mail: vincent1680616@yahoo. com.tw. DOI: 10.1097/01.mlg.0000237804.38761.81 Laryngoscope 116: November 2006 Chen et al.: Prognostic Value of Tumor Volume in Hypopharyngeal Cancer 2012