TOPLINE:

Predefined surgical high-risk structural zones identified on preoperative imaging, especially the involvement of the vertical anterior commissure (AC), predicted poorer survival and locoregional control (LRC) after primary chemoradiotherapy in patients with T2-T3 glottic carcinoma.

METHODOLOGY:

• Researchers retrospectively analysed 173 patients with T2-3, N0-3, M0 glottic carcinoma treated with primary chemoradiotherapy at three Dutch academic medical centres between 2014 and 2018.
• Pretreatment CT or MRI scans were scored by three experienced head-and-neck radiologists who were blinded to patient clinical outcomes.
• Scored high-risk landmarks included vocal fold muscle infiltration depth, paraglottic space involvement, thyroid cartilage infiltration, and horizontal or vertical AC involvement.
• Primary outcomes included 5-year LRC and disease-specific survival (DSS) rates, compared using univariate log-rank tests and Cox proportional hazard ratios (HRs) for the multivariable analysis.
• The median follow-up duration was 62 months.

TAKEAWAY:

• The overall cohort achieved 5-year rates of 71.4% for LRC, 86.7% for laryngeal preservation, 80.9% for DSS, and 56.9% for overall survival.
• In the univariate analysis, vertical AC involvement vs no involvement was linked to reduced 5-year LRC (58.2% vs 76.3%; P = .037) and DSS (62.9% vs 88.9%; P = .001), and horizontal AC involvement vs no involvement was linked to "reducing" 5-year LRC (61.7% vs 80.6%; P = .043) and DSS (73.0% vs 88.6%; P = .066).
• Anterior paraglottic space infiltration was associated with reduced 5-year LRC (63.8% vs 81.6%; P = .047) but not DSS (78.3% vs 85.2%; P = .398).
• In the multivariable analysis, vertical AC involvement retained a trend towards lower DSS (HR, 2.484; P = .087), although no variables achieved statistical significance.

IN PRACTICE:

"This study shows that known surgical predictive factors related to tumor extension into certain high-risk areas within the larynx, particularly vertical AC involvement, are likely associated with poorer locoregional control and survival, also in patients treated conservatively with (C)RT [(chemo)radiotherapy]," the authors wrote.

"Furthermore, involvement of the anterior PGS [paraglottic space] and depth of tumor infiltration carry potential predictive value but require further validation," they added.

SOURCE:

The study was led by Agatha S. Baidun, Leiden University Medical Center, Leiden, Netherlands. It was published online on June 19, 2026, in European Radiology.

LIMITATIONS:

The study was restricted by variable follow-up durations across centres, scan interpretation by three separate radiologists using differing acquisition techniques and protocols, a potentially underpowered sample, the exclusion of uncertain cases from the risk factor analysis, and the limited number of total patients and events. All potential predictors including radiotherapy dose, technique, and adjuvant chemotherapy were not assessed; however, their influence could not be ruled out.

DISCLOSURES:

The study did not receive any funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.