Has the Degree of Contrast Enhancement with MR Imaging in Laryngeal Carcinoma Added Value to Anatomic Parameters Regarding Prediction of Response to Radiation Therapy?

BACKGROUND AND PURPOSE: Our aim was to retrospectively investigate the prognostic significance of the degree of contrast enhancement in tumors and its additional value in previously considered MR imaging parameters with regard to local control of laryngeal cancer treated with radiation therapy (RT) alone. MATERIALS AND METHODS: Pretreatment MR images of 64 consecutive patients (54 men and 10 women, 43-80 years of age) with supraglottic and glottic cancer were retrospectively reviewed on clinical and previously considered MR imaging parameters such as tumor involvement of specific laryngeal anatomic subsites, including laryngeal cartilages, tumor volume, extralaryngeal tumor spread, and, in addition, the degree of contrast enhancement. Clinical and MR imaging parameters were associated with regard to local control at 2 years by using the Cox regression model. "Local control" was defined as absence of primary tumor recurrence. RESULTS: When using a threshold of the mean average contrast enhancement of 77%, the 2-year local control rate in the groups of patients with a degree of enhancement below and above this threshold was 57% and 70%, respectively (P=.3). Enhancement of tumor tissue in pre-epiglottic space (PES) was low, most probably due to its adipose tissue and poor vascular content, whereas tumor tissue involving paraglottic space (PGS) did enhance. Results of multivariate analysis indicated that the degree of contrast enhancement yielded the prognostic information (P=.07) with 2 independent prognostic factors: primary tumor volume (P=.007) and subglottic extension (P=.002) with regard to local control. Using these previously mentioned 3 MR imaging parameters as potential risk factors, we defined 4 categories, resulting in the following local control rates respectively: 90% for the group without risk factors, 73% for the group with 1, 60% for the group with 2, and finally 0% for the group with 3 risk factors, which was significantly lower than the rates in previous risk groups (P < .001). CONCLUSION: PES has a lower degree of contrast enhancement than the PGS and may correlate with the worse outcome. Including a low degree of contrast enhancement as a parameter to primary tumor volume and subglottic extension may increase the predictive value of MR imaging for local outcome and may be helpful to identify a subset of patients whose tumors all recurred locally within 2 years after primary RT.     

Dynamic helical CT of T1 and T2 glottic carcinomas: predictive value for local control with radiation therapy

BACKGROUND AND PURPOSE: Tumor volume and cartilage invasion have been suggested as prognostic factors of glottic carcinomas following definitive radiation therapy. Radiologic examinations provide additional information regarding the deep extension of tumor. We determined whether dynamic helical CT can predict local control of early (T1 and T2 stage) glottic carcinomas treated with definitive radiation therapy. METHODS: Sixty-eight patients with early glottic carcinoma evaluated on pretreatment dynamic helical CT were treated with definitive radiation therapy. Tumor detectability, maximum dimension, tumor volume, and involvement of anatomic subsites (anterior commissure, ventricle, subglottic region, and thyroid and arytenoid cartilages) were determined by consensus by three radiologists without previous knowledge of the clinical information. The CT findings were correlated with local control. RESULTS: The two-year local control rate was 76%; 91% for T1 and 60% for T2 lesions. Univariate analysis revealed clinical T stage, tumor detectability, maximum dimension, tumor volume, anterior commissure involvement, ventricle involvement, and thyroid cartilage involvement as significant prognostic factors. Thyroid cartilage involvement was an independent predictor by multivariate analysis. The lesions separate from the thyroid cartilage had a 95% probability of local control, whereas the lesions adjacent to the cartilage had only a 42% control rate. CONCLUSION: Dynamic helical CT provides prognostic information for the results of definitive radiation therapy. Patients with a tumor adjacent to the thyroid cartilage had an increased risk of local failure.     

Influence of CT on tumor classification of laryngeal carcinomas.

The routine use of CT in 51 consecutive patients with squamous cell carcinoma of the larynx revealed cartilage involvement or extralaryngeal tumor growth consistent with a T4 tumor which made 14 patients candidates for laryngectomy. Only 5 of these had a T4 classification by clinical examination while 8 cases were upstaged from T3. Except for one supraglottic tumor upstaged from T2 to T4, CT did not change the classification for T1 and T2 tumors, whose localization was mainly glottic, and there were 2 false-negative examinations. It is concluded that CT is mandatory only in advanced tumors of the glottic region or when the anterior commissure is involved. However, in suspected malignancies of the sub- or supraglottic regions CT should always be carried out because these patients are at an increased risk of unexpected deep tumor growth.     

Correlation of local outcome after partial laryngectomy with cartilage abnormalities on CT

BACKGROUND AND PURPOSE: The prognostic significance of laryngeal cartilage abnormalities, as seen on CT or MR imaging, in laryngeal or hypopharyngeal cancer, is unclear. The purpose is to determine whether cartilage abnormalities as seen on preoperative CT in laryngeal and pyriform sinus cancer are predictive of local outcome after partial laryngectomy. METHODS: The preoperative CT studies in a consecutive series of 16 patients who underwent extended hemilaryngectomy for squamous cell carcinoma of the glottis (n = 12), supraglottis (n = 1), or pyriform sinus (n = 3) were reviewed retrospectively. Cartilage abnormalities were defined as asymmetric cartilage sclerosis, lysis of ossified cartilage, or tumor visible on both sides of the cartilage. Tumor volume was calculated by using the summation-of-areas technique. Seven patients underwent postoperative radiation therapy. All patients had a follow-up of at least 24 months after treatment or until local recurrence. RESULTS: Eleven patients showed cartilage abnormalities. In six patients, only a single cartilage was abnormal, whereas three patients showed involvement of two cartilages and two patients of three cartilages. The overall average tumor volume was 2.7 mL; the average tumor volume was 1.5 mL in the patients without and 3.3 mL in those with cartilage involvement on CT (P > .05). Two patients suffered a local recurrence. One patient (tumor volume, 1.5 mL) did not show any cartilage abnormalities. The other patient (tumor volume, 1.9 mL) showed abnormalities in all three cartilages and also had evidence of early transcartilaginous tumor spread. CONCLUSION: In patients whose cancer is anatomically suitable for partial laryngectomy, cartilage abnormalities on CT do not preclude speech-preserving surgery.     

Early glottic squamous cell carcinoma. Predictive value of MR imaging for the rate of 5-year local control with radiation therapy

Purpose:
To evaluate MR findings in early (T1 and T2 stages) glottic carcinomas and the predictive value of MR imaging for the rate of 5-year local control with radiation therapy.
Material and Methods:
Eighty-three patients with early glottic carcinomas were prospectively examined with MR at 1.5 T. MR investigation included unenhanced T1-weighted, T2-weighted, dynamic and contrast-enhanced T1-weighted images. Three patients with presumed advanced diseases on MR were initially treated with total laryngectomy and were excluded from the study. The remaining 80 patients were treated with radiation therapy with curative intent. Tumor detectability, size and relationship to the thyroid cartilage were determined on MR images. The MR findings were then correlated with the rate of local control.
Results:
Forty-eight of 80 lesions (60%) were detected on MR imaging. All detected lesions but 1 demonstrated increased signal on T2-weighted images. The lesions were best delineated on dynamic images (statistically significant). The 5-year local control rate with radiation therapy was 72%. Univariate analysis revealed clinical T stage, MR detectability, tumor size and relationship to the thyroid cartilage as significant predictors. Multivariate analysis revealed that the relationship to the thyroid cartilage was an independent factor.
Conclusion:
MR provides prognostic information about the results of definitive radiation therapy. To evaluate the tumor extension in lesions detected on precontrast MR images, contrast-enhanced dynamic images should be obtained.     

Impact of cartilage invasion on treatment and prognosis of laryngeal cancer

Invasion of laryngeal cartilage has long been considered as a contraindication to radiation treatment and to all types of conservation surgery. With the advent of axial imaging techniques clarification of the submucosal extent of disease became possible. However, controversies regarding diagnosis (preferred modality, accuracy of detection of cartilage invasion) and treatment of cartilage invasion (Is cartilage invasion really a contraindication for irradiation treatment?) arose. Based on currently accepted criteria, CT appears to be more specific in detecting neoplastic cartilage invasion than MRI, but tends to underestimate invasion and may therefore result in undertreatment. Magnetic resonance has a higher sensitivity than CT for detection of cartilage invasion. The superiority of MRI lies in its ability to detect intracartilaginous tumor spread. Unfortunately, MR findings suggesting neoplastic cartilage invasion may be false positive in a considerable number of instances. Two MRI-dependent parameters appear to be significant as a prognostic factor for success of radiation therapy: tumor volume and abnormal MR signal pattern in cartilage. Minimal abnormal MR signal patterns in cartilage in patients with small tumors (under 5 cc) does not appear to be a very ominous finding for tumor recurrence after radiation therapy. On the other hand, abnormal MR signal pattern in cartilage combined with large tumor volume (above 5 cc) appears to worsen the prognosis significantly. If voice conservation surgery is being considered, MR imaging is useful for assesing those structures (such as cartilages) whose involvement would contraindicate partial laryngectomy. Magnetic resonance imaging appears to be the optimal method of examination in cooperative patients. If MRI fails or if it is contraindicated, CT may still be recommended. The radiologist's experience with CT or MRI also determines the choice between the two modalities.     

Cancer of the glottis: prognostic factors in radiation therapy

The authors conducted a multivariate analysis of the prognostic factors in 96 patients with early glottic cancer treated by radiation therapy. Of these, 73 had T1 and 23 had T2 tumor. The primary tumor was controlled in 82% of T1 and 74% of T2 lesions. Actuarial five-year survival rates were 87% for T1 and 74% for T2. Carcinoma of the anterior commissure associated with bilateral vocal cord involvement, subglottic tumor extension, persistent or recurrent laryngeal edema, and impaired cord mobility was found to adversely influence the prognosis. The data suggest that irradiation is the treatment of choice for glottic cancer limited to the vocal cords or with minimal extension to the anterior commissure or supraglottic larynx.     

Can pretreatment CT predict local control of T2 glottic carcinomas treated with radiation therapy alone?

PURPOSETo determine whether pretreatment CT can predict local control of T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy alone.METHODSPretreatment CT studies were retrospectively evaluated by two head and neck radiologists in 28 patients with T2 squamous cell carcinoma of the glottic larynx treated with definitive radiation therapy. All patients were followed for a minimum of 2 years. A tumor score was calculated based on the CT findings of tumor involvement of the following areas: the anterior commissure, the contralateral true vocal cord, the arytenoid face, the interarytenoid region, the laryngeal ventricle, the paraglottic space at the true and false vocal cord levels, and the subglottic region. Tumor volumes based on pretreatment CT were measured in each patient using a computer digitizer. Statistical analysis was performed using the independent sample t test, Wilcoxon''s rank sum test, and Fisher''s Exact Test.RESULTSThere was no statistically significant relationship between tumor volume or tumor score and outcome of the T2 glottic tumors treated with definitive radiation therapy in this series. The overall local control rate was 82%. There were no treatment complications that resulted in loss of laryngeal function.CONCLUSIONSLike low-volume supraglottic and T3 glottic carcinomas, T2 glottic squamous cell carcinoma is likely (82%) to be controlled with definitive radiation therapy. Failure to control the primary tumor is attributable to factors other than volume, which may not be detectable on CT, such as tumor-host biological factors. Pretreatment CT, however, is beneficial for detecting submucosal spread across the ventricle and subglottic extension, which might contraindicate vertical hemilaryngectomy and might not be apparent on endoscopic examination.     

MRI T-staging of laryngeal tumours: role of contrast medium

Our aim was to evaluate the relative diagnostic accuracy of MRI without contrast medium and MRI before and after contrast medium in the assessment of T-staging of laryngeal tumours. We studied 25 men (mean age 51.8, range 41–61) with laryngeal squamous cell carcinomas, using Spin-echo (SE) T1-weighted and fast SE T2-weighted sequences. The T1-weighted sequences were then repeated after gadolinium-diethylene-triaminepenta-acetic acid (Gd DTPA) 0.1 ml/kg. All patients then underwent biopsy and surgery. Two radiologists independently assessed the anonymised images by filling-out two multiple-choice forms, one for each technique, at a 2 week interval. The forms included a judgement concerning tumour identification and infiltration of the anterior commissure, supraglottic region, arytenoid cartilage, Morgagni's ventricle, paraglottic space, thyroid and cricoid cartilages, thyro-hyo-epiglottic space, vocal cords, subglottic region, and epiglottis. Similar forms were filled out by the surgeon and the pathologist after surgery. The sensitivity, specificity and diagnostic accuracy of MRI were unaffected by the use of contrast medium. Since it did not provide additional staging information, its continued routine use in these cases is not justified. Received: 13 November 1998/Accepted: 6 April 1999     

Advanced laryngeal cancer: sonographic assessment

Endoscopy permits visualization of the endolaryngeal spread of laryngeal tumors, yet the depth of tumor infiltration often remains unclear. The authors used high-resolution sonography in 37 patients with advanced laryngeal cancer to assess the tumors and the cervical lymph nodes. Sonographic findings were compared to operative and histologic reports. Sonography demonstrated histologically confirmed infiltration into the thyroid (n = 8) and cricoid cartilages (n = 1), preepiglottic space (n = 12), base of the tongue (n = 4), hypopharynx (n = 8), subglottic space (n = 3), and thyroid gland (n = 2). Except for the retrolaryngeal portion of the tumor, sonography was valuable in assessing extralaryngeal spread of advanced cancers. It enabled detection of subclinical lymph node metastases in four patients. Furthermore, invasion of the wall of the carotid artery was found in two patients. For evaluating the endolaryngeal and hypopharyngeal portions of the tumor, endoscopy remains mandatory.     

肿瘤侵犯食管入口的影像学表现

目的：分析肿瘤侵犯食管入口（环咽）的X线、CT和MRI表现,探讨肿瘤侵犯食管人口的影像诊断标准。方法：回顾分析27例经临床、病理证实的侵犯食管入口病变的X线、CT和MRI表现。包括原发于食管环咽段的鳞癌4例,颈段食管癌侵犯食管入口5例,梨状窝癌侵犯食管入口7例,喉癌侵犯食管入口6例,甲状腺癌侵犯食管入口5例。结果：27例常规X线均见剂通过食管入口受阻,16例见食管入口狭窄、黏膜破坏等征象。23例经CT或MRI发现食管环咽段增厚伴杓状软骨破坏,或环－椎间距增大,14例MRI均发现肿块与食管入口的界限模糊、消失,7例CT发现杓状软骨破坏,6例甲状软骨破坏。结论：CT或MRI发现食管环咽段增厚伴杓－椎间距或环－椎间距增大,MRI发现肿块与食管入口的界限模糊、消失,X线吞钡检查食管入口狭窄、黏膜破坏等征象是食管入口受侵的特征性改变。     

螺旋CT及其图像处理技术对喉部肿瘤侵犯的诊断价值

目的：将横断面图像,多平面重建（MPR）图像和仿真内窥镜（VE）图像结合起来综合评价喉部肿瘤的侵犯范围。方法：20例拟诊喉及下咽癌的患者行术前前瞻性螺旋CT检查并行图像后处理（MPR和VE）。采用盲法阅片,将横断面图像结果与横断面,MPR,VE联合图像结果分别与手术病理结果对照。结果：联合图像对评价室带,声带,前联合,声门下,甲状软骨,喉外结构受侵的总敏感性,特异性,准确性分别为：100％,98．5．％,99．2％,横断面图像分别为：92．4％,89．5％,90．8％;两者比较其特异性,准确性在统计学上差异有显著性意义（P值分别为：0．028,0．003）。对于杓状软骨,声门旁间隙及会厌前间隙的评价,联合图像与横断面图像结果一致。结论：对室带,声带,前联合,声门下,甲状软骨,喉外结构的受侵采用横断面结合MPR和(或）VE有助于提高诊断水平,对于杓状软骨,声门旁间隙及会厌前间隙,目前MPR及VE对诊断尚不能提供更多帮助。     

The potentials and limits of the radiotherapy of laryngeal carcinoma]

Early stage glottic carcinoma can be treated with primary radiotherapy reaching equally good results compared to primary surgery; for supraglottic carcinoma surgery offers only slight advantages over primary radiotherapy. Tumor control for recurrences is considerably improved by salvage surgery. The use of primary radiotherapy allows improved or at least preserved voice and reduced rates of acute complications and late treatment sequelae. However, treatment duration is longer and probably more expensive compared to function preservation microlaryngoscopic surgery. Which treatment approach is chosen, depends on individual patient factors and specific conditions in the clinical setting. In any case, primary radiotherapy deserves a stronger say in the early stage tumor situation. In our institution early stage supraglottic carcinomas undergo primary surgery. Advanced carcinomas (T2b and more) are rarely suited for primary radiotherapy with the exception of some very confined T3 tumors. Surgical approaches should be favoured, since they provide a detailed pathohistological tumor staging including R-classification, which would be lacking using primary radiotherapy. There are clear reasons to treat the lymph nodes for glottic carcinomas stage T2b and more and for all supraglottic carcinomas with radiotherapy. Specific risk factors are: tumor at the margins of the incision (R1), infiltration of the cartilage and pre-epiglottic space, paratracheal and subglottic extension of more than 1 cm, perineural invasion, grade III and IV as well as emergency tracheostomy. Postoperative radiotherapy should be given to the lymph nodes for all positive neck-dissections. New therapeutic approaches are on the horizon, which may improve the results of radiotherapy even for advanced larynx carcinomas, like hyperfractionation radiotherapy and simultaneous radio-chemotherapy combined enoral resection and postoperative radiotherapy may yield larynx preservation even for advanced stages. New imaging techniques allow an improved staging and predictive radiobiological assays may play a major role in tumor prognosis.     

Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR imaging, and FDG PET and validation with surgical specimen

PURPOSE: To compare computed tomography (CT), magnetic resonance (MR) imaging, and fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for delineation of gross tumor volume (GTV) in pharyngolaryngeal squamous cell carcinoma and to validate results with the macroscopic surgical specimen when available. MATERIALS AND METHODS: Twenty-nine patients with stages II-IV squamous cell carcinoma treated with radiation therapy or chemotherapy and radiation therapy (n = 20) or with total laryngectomy (n = 9) were enrolled. Ten patients had oropharyngeal, 13 had laryngeal, and six had hypopharyngeal tumors. CT, MR imaging, and PET were performed with patients immobilized in a customized thermoplastic mask, and images were coregistered. GTVs obtained with the three modalities were compared quantitatively and qualitatively. If patients underwent total laryngectomy, images were validated with the surgical specimen after three-dimensional coregistration. The effect of each modality was estimated with linear mixed-effects models. Adjustments for multiple comparisons were made with the Bonferonni or Sidak method. RESULTS: For oropharyngeal tumors and for laryngeal or hypopharyngeal tumors, no significant difference (P >.99) was observed between average GTVs delineated at CT (32.0 and 21.4 cm(3), respectively) or MR imaging (27.9 and 21.4 cm(3), respectively), whereas average GTVs at PET were smaller (20.3 [P 相似文献   

Monitoring of tumor microcirculation during fractionated radiation therapy in patients with rectal carcinoma: preliminary results and implications for therapy

PURPOSE: To measure microcirculatory changes during chemoirradiation and to correlate perfusion index (PI) values with therapy outcome. MATERIALS AND METHODS: Perfusion data in 11 patients with cT3 (clinical staging, tumor invaded the perirectal tissue) rectal carcinoma who underwent preoperative chemoirradiation were analyzed. Perfusion data were acquired by using a T1 mapping sequence with a whole-body magnetic resonance (MR) imager. After contrast medium was intravenously infused at a constant rate, concentration-and-time curves were evaluated for arterial blood and tumor. All patients underwent MR imaging before and at constant intervals during chemoirradiation. Clinical stages before therapy were compared with surgical stages after therapy. RESULTS: Spatial and temporal resolution on dynamic T1 maps were sufficient to reveal changes in contrast medium accumulation in the tumor. Comparison of PI values and radiation dose showed a significant increase in the 1st (P: =.003) and 2nd weeks (P: =.01) of treatment; values subsequently returned to pretreatment levels or showed a renewed increase. High initial PI values correlated with greater lymph node downstaging (P: =.042). CONCLUSION: Dynamic T1 mapping provides a suitable tool for monitoring tumor microcirculation during chemoirradiation and offers the potential for individual optimization of therapeutic procedures. Furthermore, these results indicate that the PI map may serve as a prognostic factor.     

Computed tomography in T1 carcinoma of the larynx

The findings at computed tomography (CT) were reviewed in 33 patients with laryngeal carcinoma classified as T1 at clinical examination. CT revealed extralaryngeal growth and thus changed the classification to T4 in 6 of the 20 patients with a supraglottic primary tumor, but in none of the 13 patients with a glottic tumor.     

CT findings in chondroradionecrosis of the larynx.

PURPOSEOur goal was to describe the CT findings before and after radiation therapy in a series of patients with laryngeal chondroradionecrosis.METHODSThe CT studies obtained before and after radiation therapy in nine patients with the diagnosis of laryngeal chondroradionecrosis were reviewed retrospectively.RESULTSCT scans revealed abnormalities in all patients. A variable degree of laryngeal soft-tissue swelling was seen in eight of the patients. In four patients, cartilaginous abnormalities were visible initially, and appeared in three of four other patients who had further follow-up CT studies. Six patients had involvement of the thyroid cartilage; collapse of the thyroid cartilage was seen in two cases and gas bubbles were visible adjacent to the thyroid cartilage in three cases. Four patients with involvement of the thyroid cartilage eventually underwent total laryngectomy, and one died suddenly in severe respiratory distress. In all three patients with arytenoidal involvement, anterior dislocation of this cartilage was seen; in two of these patients, the adjacent part of the cricoid cartilage showed some sclerosis. Two patients with arytenoidal necrosis (both with cricoidal sclerosis) kept a functional larynx. In one case, cricoidal sclerosis was seen in association with lysis of the thyroid cartilage.CONCLUSIONThe CT appearance of laryngeal chondroradionecrosis is nonspecific, but the diagnosis can be strongly suggested in cases of sloughing of the arytenoid cartilage, fragmentation and collapse of the thyroid cartilage, and/or in the presence of gas bubbles around the cartilage.     

Primary staging of laryngeal and hypopharyngeal cancer: CT,MR imaging and dual-energy CT

Laryngeal and hypopharyngeal cancer, in particular T4a disease associated with cartilage invasion and extralaryngeal spread, needs to be evaluated accurately because treatment can impact heavily on a patient's quality of life. Reliable imaging tools are therefore indispensible. CT offers high spatial and temporal resolution and remains the preferred imaging modality. Although cartilage invasion can be diagnosed with acceptable accuracy by applying defined criteria for combinations of erosion, lysis and transmural extralaryngeal spread, iodine-enhanced tumors and non-ossified cartilage are sometimes difficult to distinguish. MR offers high contrast resolution for images without motion artifacts, although inflammatory changes in cartilage sometimes resemble cartilage invasion. With dual-energy CT, combined iodine overlay images and weighted average images can be used for evaluation of cartilage invasion, since iodine enhancement is evident in tumor tissue but not in cartilage. Extralaryngeal spread can be evaluated from CT, MR or dual-energy CT images and the routes of tumor spread into the extralaryngeal soft tissue must be considered; (1) via the thyrohyoid membrane along the superior laryngeal neurovascular bundle, (2) via the inferior pharyngeal constrictor muscle, and (3) via the cricothyroid membrane. Radiologists need to understand the advantages and limitations of each imaging modality for staging of laryngeal and hypopharyngeal cancer.     

Retinoblastoma: Abnormal gadolinium enhancement of anterior segment of eyes at MR imaging with clinical and histopathologic correlation

PURPOSE: To evaluate abnormal gadolinium enhancement of the anterior segment of eyes harboring retinoblastoma at magnetic resonance (MR) imaging and correlate this finding with clinical and histopathologic information. MATERIALS AND METHODS: Three neuroradiologists examined 46 eyes with 34 retinoblastomas in 25 children on gadolinium-enhanced T1-weighted orbital MR images obtained shortly after contrast material injection for evidence of abnormally high signal intensity in the anterior segment. Twenty-two of the 34 affected eyes were enucleated, and six of these 22 eyes were treated with preenucleation adjuvant therapy. Thus, correlation of the clinical, MR imaging, and histopathologic findings in 16 eyes was performed. Statistical analysis was performed with nonparametric methods (Fisher exact test). P <.05 indicated a statistically significant difference. RESULTS: Fourteen of the 34 affected eyes showed abnormal gadolinium enhancement of the anterior segment. Regarding the 16 eyes evaluated for statistical analysis, a significant correlation (P =.011) between abnormal gadolinium enhancement of the anterior segment and histopathologically documented optic nerve infiltration was noted. A trend toward an association between abnormal enhancement and elevated intraocular pressure (P =.215), tumor growth beyond the equator at MR imaging (P =.125), and histopathologically proved iris neoangiogenesis (P =.182) also was noted. Histopathologic evidence of optic nerve and/or choroid infiltration correlated significantly (P =.001; sensitivity, 100% [nine of nine eyes]; specificity, 86% [six of seven eyes]) with abnormal enhancement. CONCLUSION: Abnormal gadolinium enhancement of the anterior segments of eyes harboring retinoblastoma seems to indicate more aggressive tumor behavior.     

Comparison of the results of surgery and radiotherapy in 175 cases of T2 glottic carcinoma: 116 operated and 59 irradiated cases

The results were analyzed of 175 patients with glottic squamous cell carcinomas who were treated with curative purposes (1970-1986). One hundred and sixteen of them underwent surgery at the Otolaryngology Department of the University of Florence, and 59 were treated by radiation therapy at the Florence University and Hospital Departments of Radiotherapy. In the surgical series 78 cases were treated with radical surgery and 38 with conservative surgery. All patients were staged according to TNM system (UICC 1978) as T2. Overall 10-year local control rates were 74% for the surgical series and 69% for the cases treated by radiation therapy. After salvage therapy 10-year survival rates were 83% and 76%, respectively. The analysis of the results showed no statistically significant difference. In the group treated by radical surgery 80% local control was observed, versus 66% in the cases treated with conservative surgery. 10-year survival rate was higher in the latter group (89% versus 81%) because of better results of salvage therapy: 7 of 10 recurrences were salvaged with the second treatment. Several prognostic factors were evaluated, i.e., T extent, anterior commissure involvement, subglottic invasion, vocal cord mobility impairment, and ventricular involvement. Anterior commissure involvement was the main factor affecting outcome in the surgical series: in the presence of this factor, 64% 10-year local control was observed versus 85% in the patients without commissure involvement. This factor proved more important in the patients treated with conservative surgery (10-year control: 42% versus 88%) than in those undergoing radical surgery (78% versus 85%). Anterior commissure involvement and the number of involved subsites were found to worsen prognosis in the series treated by radiation therapy: cases with anterior commissure involvement had 59% 10-year local control versus 83%. The cases with a deeper spread had 60% local control versus 75%. Vocal cord mobility impairment was a less important prognostic factor in both series. Our results suggest radiation therapy as a valuable method in the treatment of the small T2 laryngeal cancers which are not suitable for conservative surgery.