Correlation between nodal density in contrasted scans and response to cisplatin-based chemotherapy in head and neck squamous cell cancer: A prospective validation
Corresponding Author
François Janot MD
Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France
Department of Head and Neck Surgery, Institut Gustave-Roussy, rue Camille Desmoulins, 94805, Villejuif, FranceSearch for more papers by this authorEsteban Cvitkovic MD
Department of Oncology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorJean Daniel Piekarski MD
Department of Radiology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorRobert Sigal MD
Department of Radiology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorJean Pierre Armand MD
Department of Oncology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorAmine Bensmaine MD
Department of Oncology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorBernard Luboinski MD
Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorCorresponding Author
François Janot MD
Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France
Department of Head and Neck Surgery, Institut Gustave-Roussy, rue Camille Desmoulins, 94805, Villejuif, FranceSearch for more papers by this authorEsteban Cvitkovic MD
Department of Oncology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorJean Daniel Piekarski MD
Department of Radiology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorRobert Sigal MD
Department of Radiology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorJean Pierre Armand MD
Department of Oncology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorAmine Bensmaine MD
Department of Oncology, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorBernard Luboinski MD
Department of Head and Neck Surgery, Institut Gustave-Roussy, Villejuif, France
Search for more papers by this authorAbstract
This prospective study was done to validate an earlier retrospective study demonstrating a relationship between complete response to chemotherapy and nodal density as estimated in contrasted computed tumorgraphy (CT scans) in head and neck squamous cell carcinoma (HNSCC). CT scans of 36 patients were evaluated by two radiologists blinded to therapeutic outcome. The density of the largest node (>2 cm) was compared to that of nuchal muscles. A node was classified as hypodense if more than 33% of the nodal surface area consisted of hypodense zones. Density and nodal staging were related: 67% (10 of 15) of patients with N3 disease but only 29% (six of 21) with N1–N2 exhibited isodensity, p < 0.05. Complete response to chemotherapy was noted in 63% (10 of 16) of the isodense group but only in 15% (three of 20) of the hypodense group, p < 0.01. We believe that nodal density can be used for therapeutic decision-making in high nodal volume HNSCC.
References
- 1 Taylor SG. Why has so much chemotherapy done so little in head and neck cancer. J Clin Oncol 1987; 5: 1–3.
- 2 Stell PM, Rawson NSB. Adjuvant chemotherapy in head and neck cancer. Br J Cancer 1990; 61: 779–787.
- 3 Cognetti F, Pinnaro P, Ruggeri EM, et al. Prognostic factors for chemotherapy response and survival using combination chemotherapy as initial treatment of advanced head and neck squamous cancer. J Clin Oncol 1989; 7: 829–837.
- 4 Tannock IF, Browman G. Lack of evidence for a role of chemotherapy in the routine management of locally advanced head and neck cancer. J Clin Oncol 1986; 4: 1121–1126.
- 5 Munck JN, Cvitkovic E, Piekarski JD, et al: Computed tomography density of metastatic lymph nodes as a treatment-related prognostic factor in advanced head and neck cancer. JNCI 1991; 83: 569–575.
- 6 International Union Against Cancer. TNM classification of malignant tumors. New York: Springer-Verlag, 1987.
- 7 Weaver A, Fleming S, Ensley J, et al. Superior clinical response and survival rates with initial bolus of cisplatin and 120 hours infusion of 5-fluorouracil before definitive therapy for locally advanced head and neck cancer. Am J Surg 1984; 148: 525–529.
- 8 Tellez Bernal E, Cvitkovic E, Guillot T, et al. Phase II feasibility study of cisplatinum and continuous infusion of vindesin and 5 fluorouracil with folinic acid in advanced squamous cell carcinoma. Proc Am Soc Clin Oncol 1990; 9: 678.
- 9 WHO handbook for reporting results of cancer treatment. Geneva: World Health Organization, 1979.
- 10 Cachin Y. Les modalités et la valeur pronostique de l'envahissement ganglionnaire cervical dans les carcinomas de voies aéro-digestive supérieures. Vie Med 1972; 4: 46–58.
- 11 Cachin Y, Sancho-Garnier H, Micheau C, Marandas P. Nodal metastasis from carcinoma of the oropharynx. Otolaryngol Clin North Am 1979; 12: 145–154.
- 12 Stell PM, Morton RP, Singh SD. Cervical lymph node metastasis. The significance of the level of the lymph node. Clin Oncol 1983; 9: 101–107.
- 13 Johnson JT, Barnes EL, Myers EN, Schramm VL, Borochovitz D, Sigler BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol 1981; 107: 725–729.
- 14 Broders AC. Carcinoma of the mouth: types and degrees of malignancy. Am J Roentgenol Rad Ther Nucl Med 1927; 17: 90–93.
- 15
Crissman JD,
Liuw Y,
Gluchman JL,
Cummings G.
Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx.
Cancer
1984;
54:
2995–3001.
10.1002/1097-0142(19841215)54:12<2995::AID-CNCR2820541230>3.0.CO;2-R CAS PubMed Web of Science® Google Scholar
- 16
Ensley JF,
Kish JA,
Weaver AA, et al.
The correlation of specific variables of tumor differentiation with response rate and survival in patients with advanced head and neck cancer treated with induction chemotherapy.
Cancer
1989;
63:
1487–1492.
10.1002/1097-0142(19890415)63:8<1487::AID-CNCR2820630806>3.0.CO;2-4 CAS PubMed Web of Science® Google Scholar
- 17 Schantz SP, Savage HF, Racz T, et al. Immunologic determinants of head and neck cancer response to induction chemotherapy. J Clin Oncol 1989; 7: 857–864.
- 18 Ensley JF, Maciorowski Z, Pietraszkiewicz H, et al: Clinical applications of cellular DNA content parameters determined by flow cytometry in squamous cell cancers of the head and neck. In: SE Salmon, ed. Adjuvant therapy of cancer Philadelphia: WB Saunders, 1990; 101–108.
- 19 Beg AC, Hofland L, Moonen H, et al. The predictive value of cell kinetic measurement in a European trial of accelerated fractionation in advanced head and neck tumors: an interim report. Int J Radiat Oncol Biol Phys 1990; 19: 1449–1453.
- 20 Mancuso AA, Harnsgerger HR, Muraki A, et al. Computed tomography of cervical and retropharyngeal lymphnodes: normal anatomy, variants of normal, and application in staging head and neck cancer. Part I: normal anatomy, part II: pathology. Radiology 1983; 148: 709–723.
- 21 Som PM. Lymph nodes of the neck. Radiology 1987; 165: 593–600.
- 22 Moreau P, Goffard Y, Collignon J. Computed tomography of metastatic lymph nodes. Arch Otolaryngol 1990; 116: 1190–1193.
- 23 Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR 1992; 158: 961–969.
- 24
Wolf TW,
Markuch RW,
Balser SR.
Predictive factors for tumor response to preoperative chemotherapy in patients with head and neck squamous carcinoma. The Head and Neck Contract Program.
Cancer
1984;
54:
2869–2877.
10.1002/1097-0142(19841215)54:12<2869::AID-CNCR2820541210>3.0.CO;2-N CAS PubMed Web of Science® Google Scholar
- 25
Recondo G,
Cvitkovic E,
Azli N, et al.
Neoadjuvant chemotherapy consisting of cisplatin and continuous infusions of bleomycin and 5-fluorouracil for advanced head and neck cancer.
Cancer
1991;
68:
2109–2119.
10.1002/1097-0142(19911115)68:10<2109::AID-CNCR2820681004>3.0.CO;2-M CAS PubMed Web of Science® Google Scholar
- 26 Janot F, Laccourreye H, Bassot V, Brasnu D, Menard M, Fabre A. Réponse tumorale et ganglionnaire à la chimiothérapie. Etude pronostique dans les cancers du sinus piriforme et de la margelle laryngée latérale. Ann Otolaryngol 1988; 105: 415–421.
- 27
De Vita VT.
The relationship between tumor mass and resistance to chemotherapy.
Cancer
1983;
51:
1209–1220.
10.1002/1097-0142(19830401)51:7<1209::AID-CNCR2820510707>3.0.CO;2-J PubMed Web of Science® Google Scholar
- 28 Vanpel P, Kallinowski F, Okunieff P. Blood flow, oxygen and nutrient supply and metabolic microenvironment of human tumors: a review. Cancer Res 1989; 46: 6449–6465.
- 29 Brown J. Tumor hypoxia, drug resistance and metastases. JCNI 1990; 82: 338–339.
- 30 Nugent LJ, Jain RK. Extravascular diffusion in normal and neoplastic tissues. Cancer Res 1984; 44: 238–244.
- 31 Klijanienko J, de Braud F, Russo A, et al. Tumor vascularisation in head and neck squamous cell carcinoma. Its relation to histology, ploidy and TNM staging. Proc Am Assoc Cancer Res 1991; 32: 1127.
- 32 Cvitkovic E, Klijanenko J, Munck JN, et al. Tumor vascularisation as a predictor of chemotherapy response in squamous cell carcinoma. Proc Am Assoc Cancer Res 1990; 31: 1010.
- 33 Folkman J. What is the evidence that tumors are angiogenesis dependent? JNCI 1990; 82: 4–6.
- 34 Weidner N, Semple J, Welch W, Folkman J. Tumor angiogenesis and metastasis. Correlation in invasive breast carcinoma. N Engl J Med 1991; 32: 1–8.
- 35 Gimbrone M, Cotran RS, Leapman SB, et al. Tumor growth and neovascularisation: an experimental model using the rabbit cornea. JNCI 1974; 52: 412–427.
- 36 Srivastava A, Hughes LE, Woodcock JP, Laidler P. Vascularity in cutaneous melanoma detected by Doppler sonography and histology: correlation with tumor behaviour. Br J Cancer 1989; 59: 89–91.
- 37 Klijanienko J, El Naggar A, Rodriguez R, et al. The mitotic index of primary tumors in head and neck squamous cell carcinoma is correlated to its vascularisation. Third International Conference of Head and Neck Cancer. San Francisco, California, July 26–30, 1992.
- 38 Bachouchi M, Cvitkovic E, Azli N, et al. High complete response in advanced nasopharyngeal carcinoma with bleomycin, epirubicin and cisplatin before radiotherapy. JNCI 1990; 82: 616–620.
- 39
Recondo G,
Aramand JP,
Tellez-Bernal E, et al.
Recurrent and/or metastatic head and neck squamous cell carcinoma: a clinical, univariate and multivariate analysis of response and survival with cisplatin-based chemotherapy.
Laryngoscope
1991;
101:
5.
10.1288/00005537-199105000-00009 Google Scholar
Citing Literature
