A prognostic volumetric threshold of gross tumor volume in head and neck cancer patients treated with radiotherapy

Paul B. Romesser, Muhammad M. Qureshi, Rathan M. Subramaniam, Osamu Sakai, Scharukh Jalisi, Minh T. Truong

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objectives: To determine the prognostic utility of a volumetric threshold for gross tumor volume (GTV) of the primary and nodal disease when accounting for the TNM classification in head and neck cancer (HNC) patients treated with definitive radiotherapy (RT). Materials and Methods: From 2004 to 2011, 79 HNC patients were treated to a median dose of 70 Gy, using intensity-modulated RT in 78.5% and 3-dimensional conformal RT in 21.5% with 83.5% receiving concurrent chemotherapy. Primary (GTV-P) and nodal (GTV-N) GTVs were derived from computed tomography (CT)-based contours for RT planning, of which 89.7% were aided by positron emission tomography-computed tomography. Local (LC), nodal (NC), distant (DC) control, and overall survival (OS) were assessed using the Kaplan-Meier product-limit method. Results: With a median follow-up of 27.1 months GTV-P, threshold of <32.9mL (mean value) compared with ≥32.9 mL, correlated with improved 2-year LC (96.2% vs. 63.9%, P < 0.0001), NC (100% vs. 69.2%, P < 0.0001), DC (87.9% vs. 64.2%, P = 0.001), and OS (88.4% vs. 58.6%, P = 0.001). GTV-P demonstrated its prognostic utility in multivariate analyses when adjusted for tumor category, cancer site, and chemotherapy regimen. Nodal GTV (mean, 34.0 mL) was not predictive of nodal control and survival. Conclusions: A volumetric threshold of the primary tumor may be used as an independent prognostic factor in patients with HNC undergoing definitive RT.

Original languageEnglish (US)
Pages (from-to)154-161
Number of pages8
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Issue number2
StatePublished - Apr 2014


  • Cancer staging
  • Gross tumor volume
  • Head and neck cancer
  • Intensity-modulated radiation therapy
  • PET/CT

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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