Role of Tumour Volume as a Prognostic Factor for Organ Preservation in Locally Advanced Laryngeal Cancers

Tumour volume is considered as one of the prognostic factor in determining outcomes after chemoradiation in head and neck cancer. In our study, we sought to analyse the use of tumour volume as a predictor of laryngeal preservation outcomes in locally advanced laryngeal carcinoma treated with chemoradiation. A total of 37 patients with locally advanced laryngeal carcinoma (stages III and IV) who underwent chemoradiation for the period of 2017 to 2024 were included. The pre-treatment tumour volumes were obtained from planning computed tomography images. The tumour volumes were compared to various treatment outcomes like overall survival (OS), disease free survival (DFS) and laryngeal preservation rates (LPR). Statistical analysis was done by testing hypotheses (chi-square test and independent sample t-test) to identify significant relationships or differences, evaluating diagnostic tests with ROC curves and estimating survival probabilities with the Kaplan-Meier method. The ideal cut-off for tumour volume was 13.04 cm³ which was obtained using receiver operating characteristic (ROC) curve. The 3-year OS was 75.91% (95% CI 62.789-89.642) vs. 59.47% (95% CI 43.985-74.937) (p = 0.187) and the 3-year DFS was 81.39% (95% CI 71.962-90.822) vs. 77.39% (95% CI 65.722-88.999) (p = 0.829). On univariate analysis, the tumour volume is statically significant when compared with laryngeal preservation rates [88.9% vs. 11.1% (p = 0.001)]. The pre-treatment tumour volume of laryngeal carcinoma has significant impact on the LPR. The use of pre-treatment volumes obtained from modern day imaging modalities may supplement the TNM staging system and can help identify patients who would benefit from laryngeal preservation approach and thereby significantly improving the quality of life in these patients.