Higher tumor volumes in T3 glottic cancers associated with poorer survival outcomes, according to results of a study published in JAMA Otolaryngology-Head & Neck Surgery.

The relationship between tumor volume and outcomes among patients with glottic cancers receiving primary (chemo)radiotherapy has not been firmly established.

At 7 participating cancer centers in Canada, 319 patients receiving treatment for T3 glottic cancers between 2002 and 2018 were retrospectively evaluated for survival outcomes on the basis of tumor volume. Tumor volumes were determined by expert neuroradiologists using diagnostic imaging.

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The patients were mean (SD) age 66.17 (11.58) years, 87.5% were men, 73% had a Charlson Comorbidity Index (CCI) score 4 or greater, 84% had N0 lymph node status, 92% had stage III disease, and 47.2% were concurrently using systemic therapy.

Overall, the mean tumor volume was 4.04 (3.92) cm3.

During an average follow-up of 3.85 years, 27% of patients died, 29% experienced local failure, 11% experienced regional failure, and 12% experienced distant metastasis. The 2-year overall survival rate was 83.7% and disease-free survival rate was 62.5%.

In the multivariate regression analysis, overall survival was associated with N+ lymph status compared with N0 status (hazard ratio [HR], 3.67), CCI score 4 or greater (HR, 2.20), tumor volume (HR, 1.07 per 1-cm3 increase), and age at diagnosis (HR, 1.06 per 1-year increase).

Disease-free survival was associated with CCI score 4 or greater (HR, 1.96), N+ lymph status (HR, 1.95), and tumor volume (HR, 1.04 per 1-cm3 increase).

This study may have included selection bias and inaccurate or missing data.

The study authors concluded, “Among cT3 glottic larynx cancers treated with organ preservation, increasing tumor volume was associated with worse OS [overall survival] and DFS [disease-free survival],” the study authors concluded. “In absence of randomized clinical trial evidence, we recommend up-front laryngectomy and postoperative radiotherapy in patients with large tumor volume with poor pretreatment laryngeal function,” they added.

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Malik NH, Fu R, Hainc N, et al. Association of primary tumor volume with survival in patients with T3 glottic cancer treated with radiotherapy: a study of the Canadian Head & Neck Collaborative Research Initiative. JAMA Otolaryngol Head Neck Surg. 2023;149(2):103-109. doi:10.1001/jamaoto.2022.3996