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3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Many treatment approaches are available for head and neck cancer (HNC), leading to challenges for a multidisciplinary medical team in matching each patient with an appropriate regimen. In this effort, primary diagnostics and its reliable documentation are indispensable. A three-dimensional (3D) documentation system was developed and tested to determine its influence on interpretation of these data, especially for TNM classification.

Methods

A total of 42 HNC patient data sets were available, including primary diagnostics such as panendoscopy, performed and evaluated by an experienced head and neck surgeon. In addition to the conventional panendoscopy form and report, a 3D representation was generated with the “Tumor Therapy Manager” (TTM) software. These cases were randomly re-evaluated by 11 experienced otolaryngologists from five hospitals, half with and half without the TTM data. The accuracy of tumor staging was assessed by pre–post comparison of the TNM classification.

Results

TNM staging showed no significant differences in tumor classification (T) with and without 3D from TTM. However, there was a significant decrease in standard deviation from 0.86 to 0.63 via TTM (\(p=0.027\)). In nodal staging without TTM, the lymph nodes (N) were significantly underestimated with \(0.39\pm 0.79\) classes compared with \(0.07\pm 0.69\) with TTM (\(p=0.002\)). Likewise, the standard deviation was reduced from 0.79 to 0.69 (\(p=0.032\)). There was no influence of TTM results on the evaluation of distant metastases (M).

Conclusion

TNM staging was more reproducible and nodal staging more accurate when 3D documentation of HNC primary data was available to experienced otolaryngologists. The more precise assessment of the tumor classification with TTM should provide improved decision-making concerning therapy, especially within the interdisciplinary tumor board.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008 v2.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 10. International Agency for Research on Cancer. http://globocan.iarc.fr. Accessed 18 June 2013

  2. Cancer Facts & Figures 2008 (2008) American Cancer Society, Atlanta

  3. Krebs in Deutschland 2007/2008 (2012). vol 8. Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., Berlin

  4. Cancer Facts & Figures 2013 (2013). American Cancer Society, Atlanta

  5. Blomberg M, Nielsen A, Munk C, Kjaer SK (2011) Trends in head and neck cancer incidence in Denmark, 1978–2007: focus on human papillomavirus associated sites. Int J Cancer 129(3):733–741. doi:10.1002/ijc.25699

    Article  CAS  PubMed  Google Scholar 

  6. Marur S, Forastiere AA (2008) Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc 83(4):489–501. doi:10.4065/83.4.489

    Article  PubMed  Google Scholar 

  7. Dietz A, Boehm A, Mozet C, Wichmann G, Giannis A (2008) Current aspects of targeted therapy in head and neck tumors. Eur Arch Otorhinolaryngol 265(Suppl 1):S3–S12. doi:10.1007/s00405-008-0697-6

    Article  PubMed  Google Scholar 

  8. Ang KK (2008) Multidisciplinary management of locally advanced SCCHN: optimizing treatment outcomes. Oncologist 13(8):899–910. doi:10.1634/theoncologist.2007-0157

  9. Olofsson J (2009) Multidisciplinary team a prerequisite in the management of head and neck cancer? Eur Arch Otorhinolaryngol 266(2):159–160. doi:10.1007/s00405-008-0883-6

    Article  PubMed  Google Scholar 

  10. Nguyen NP, Vos P, Lee H, Borok TL, Karlsson U, Martinez T, Welsh J, Cohen D, Hamilton R, Nguyen N, Nguyen LM, Vinh-Hung V (2008) Impact of tumor board recommendations on treatment outcome for locally advanced head and neck cancer. Oncology 75(3–4):186–191. doi:10.1159/000163058

    Article  PubMed  Google Scholar 

  11. Simo R, Morgan P, Jeannon JP, Odell E, Harrison J, Almeida B, McGurk M, Lyons A, Hussain K, Gleeson M, O’Connell M, Calman F, Ng R, Roblin P, Connor S, Fenlon M, Burke M, Chandra A, Herbert A, Patt S, Steward-Bagley L, Donnelly R, Freeman L, Twinn C, Mason C (2009) Integrated media presentation in multidisciplinary head and neck oncology meetings. Eur Arch Otorhinolaryngol 266(2):261–265. doi:10.1007/s00405-008-0819-1

    Article  PubMed  Google Scholar 

  12. Rössling I, Dornheim J, Dornheim L, Boehm A, Preim B (2011) The Tumor Therapy Manager-design, refinement and clinical use of a software product for ENT surgery planning and documentation. In: Taylor RH, Yang G-Z (eds) Information processing in computer-assisted interventions, vol 6689. Springer, Berlin, pp 1–12

    Chapter  Google Scholar 

  13. Boehm A, Dornheim J, Müller S, Strauß G, Wichmann G, Dietz A, Preim B (2010) TTM Tumor Therapy Manager. In: Burgert O, Kahrs L, Preim B, Schipper J (eds) 9. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie (CURAC). Düsseldorf, Germany, pp 17–20

  14. Boehm A, Wichmann G, Neumuth T, Pankau T, Müller S, Preim B, Dietz A (2012) Documentation and Visualisation with the TTM (Tumor Therapy Manager) for Panendoscopy: results of workflow analysis of the panendoscopy and the documentation process with or without the TTM. In: 8th International conference on head and neck cancer, Toronto, Canada

  15. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Oxford

    Google Scholar 

  16. Krüger A, Tietjen C, Hintze J, Preim B, Hertel I, Strauß G (2005) Interactive visualization for neck-dissection planning. In: Brodlie KW, Duke DJ, Joy KI (eds) EuroVis05 joint eurographics-IEEE VGTC symposium on visualization, Leeds, United Kingdom, pp 295–302

  17. Boehm A, Lindner F, Wichmann G, Bauer U, Wittekind C, Knoedler M, Lordick F, Dietzsch S, Scholz M, Kortmann R, Dietz A (2014 Jun 25) Impact of indication-shift of primary and adjuvant chemo radiation in advanced laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3134-z

  18. Dornheim L, Dornheim J, Rössling I (2010) Complete fully automatic model-based segmentation of normal and pathological lymph nodes in CT data. Int J Comput Assist Radiol Surg 5(6):565–581. doi:10.1007/s11548-010-0530-8

  19. Bohn S, Meier J, Neumuth T, Wichmann G, Strauss G, Dietz A, Boehm A (2012) Design of an integrated IT platform to support the oncologic ENT treatment process and concept of a surgical planning unit. Int J Comput Assist Radiol Surg 7(1 Supplement):402–403

    Google Scholar 

  20. Mueller S, Wichmann G, Dornheim L, Roessling I, Bertolini J, Preim B, Dietz A, Boehm A (2012) Different approaches to volume assessment of lymph nodes in computer tomography scans of head and neck squamous cell carcinoma in comparison with a real gold standard. ANZ J Surg 82(10):737–741. doi:10.1111/j.1445-2197.2012.06238.x

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank all participants and contributors to our study: Prof. Dr. med. Thomas Eichhorn, Dr. med. Eva-Maria Jenzewski, Dr. med. Stefan Koppatz (Cottbus); Prof. Dr. med. Dirk Eßer, Dr. med. Ulrich Kurze (Erfurt); Prof. Dr. med. Markus Jungehülsing, Dr. med. Jörg Berkholz, Dr. med. Christoph Erle (Potsdam); Dr. med. Hans-Joachim Vogel (Riesa); Dr. med. Thomas Berger, Dr. med. Miloš Fischer, Dr. med. Mathias Hofer and Dr. med. Christian Mozet (Leipzig). Special thanks go to Jana Dornheim, Lars Dornheim and Ivo Rössling from Dornheim Medical Images GmbH for providing the “NeckSegmenter” and technical support.

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The authors declare that they have no conflict of interest.

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Correspondence to Andreas Boehm.

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Pankau, T., Wichmann, G., Neumuth, T. et al. 3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients. Int J CARS 10, 1617–1624 (2015). https://doi.org/10.1007/s11548-014-1131-8

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  • DOI: https://doi.org/10.1007/s11548-014-1131-8

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