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MR Imaging Predictors of Local Control of Glottic Squamous Cell Carcinoma Treated with Radiation Alone¹

¹ From the Departments of Radiology (R.L., B.S., J.A.C.), Clinical Epidemiology and Biostatistics (D.L.K.), and Otolaryngology/Head and Neck Surgery (C.R.L.), VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands (J.A.L.); and Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (M.v.W.). Received April 6, 2006; revision requested June 1; revision received July 19; accepted August 23; final version accepted November 10. Address correspondence to R.L. (e-mail: Redina.Ljumanovic{at}vumc.nl).

Purpose: To retrospectively evaluate the prognostic significance of magnetic resonance (MR) imaging–determined tumor parameters, especially the presence of cartilage invasion, regarding local control of glottic squamous cell carcinoma treated with radiation therapy (RT) alone.

Materials and Methods: The study was performed with the approval of our institutional review board; direct patient consent was waived. Pretreatment MR images of 118 patients aged 41–86 years (110 men, eight women) with glottic carcinoma treated with RT alone were reviewed for tumor involvement of specific laryngeal anatomic subsites (including laryngeal cartilage), tumor volume, and extralaryngeal tumor spread; these findings were compared with local control. Local control was defined as absence of a recurrence at the primary site for 2 years. Statistical significance of differences between curves for local control estimated with the Kaplan-Meier method was tested with log-rank test.

Results: Results of univariate analysis showed all MR imaging–determined parameters to be significant predictors of local control rate, compared with clinical parameters where T classification and vocal cord mobility were the only significant parameters associated with local control. Multivariate analysis (Cox regression model) of clinical and radiologic parameters revealed that hypopharyngeal extension (P = .04) and intermediate T2 signal intensity (SI) in cartilage similar to tumor SI (P < .001) were independent prognostic factors with regard to local control.

Conclusion: Intermediate T2 SI in cartilage, which may suggest cartilage invasion, and hypopharyngeal extension of tumor, predict greater likelihood of local failure, whereas high T2 SI, which may suggest inflammatory tissue in cartilage, predicts lower likelihood of local failure.

© RSNA, 2007