Prognostic significance of computed tomography in tumors of the oral cavity and oropharynx treated with neoadjuvant chemotherapy

The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment

PURPOSE

To investigate the value of CT-derived tumor parameters as predictor of local and regional outcome of tonsillar squamous cell carcinoma treated by definitive radiation therapy.

METHODS AND MATERIALS

The pretreatment CT studies of 112 patients with tonsillar squamous cell carcinoma were reviewed. After redigitizing the films, primary and nodal tumor volume was calculated with the summation-of-areas technique. The nodal CT aspect was graded using a 3-point scale (homogenous, inhomogeneous, and necrotic). Mean follow-up time was 33 months. Actuarial statistical analysis of local and regional outcome was done for each of the covariates; multivariate analysis was performed using Cox's proportional hazards model.

RESULTS

In the actuarial analysis, CT-determined primary tumor volume was significantly correlated with local recurrence rate (p < 0.05) when all patients were considered, but primary tumor volume did not predict local control within the T2, T3, and T4 category. CT-determined nodal volume was significantly related to regional outcome (p < 0.01), but nodal density was not. Total tumor volume was not significantly related to locoregional outcome (p = 0.1). In the multivariate analysis, the T and N categories were the independent predictors of local and regional outcomes, respectively.

CONCLUSION

Compared to other head-and-neck sites, primary and nodal tumor volume have only marginal predictive value regarding local and regional outcome after radiation therapy in tonsillar cancer.

Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors

OBJECTIVE

We determined whether contrast-enhanced color Doppler sonography can differentiate benign from malignant enlarged cervical lymph nodes in head and neck tumors.

SUBJECTS AND METHODS

Ninety-four enlarged lymph nodes in 39 adult patients (32 men and seven women; age range, 30-81 years) were examined with B-mode sonography and with unenhanced and contrast-enhanced color Doppler sonography. All patients had carcinoma of the oral cavity. Histologically, lymphadenitis was found in 57 nodes and metastases in 37 nodes. Geometric dimension, texture, and margin of the node and detection and location of vessels were noted. Histology and imaging findings were correlated.

RESULTS

The transverse-to-longitudinal diameter ratio in combination with texture and margin analysis resulted in a correct diagnosis in only approximately 79% of the nodes. With contrast-enhanced color Doppler sonography, 86% of nodes showed vessels, and 28% of nodes showed vessels with this technique exclusively. Characteristic configurations were identified: hilar vessels with branching indicated lymphadenitis (sensitivity, 98%; specificity, 100%), and predominantly peripheral vessels indicated metastases (100%, 98%). These findings changed the diagnosis in 13 nodes, changed the therapy in four patients, and led to an incorrect diagnosis in one patient.

CONCLUSION

Enlarged lymph nodes can be characterized as metastatic or inflammatory with high diagnostic accuracy on the basis of their vascular architecture as seen on contrast-enhanced color Doppler sonography.