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Tumor and target volume manual delineation remains a challenging task in head and neck cancer radiation therapy. The purpose of this study was to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation magnetic resonance scans of patients with oropharyngeal cancer.We retrospectively collected pretreatment T1-weighted, T1-weighted with gadolinium contrast, and T2-weighted magnetic resonance imaging scans for 4 patients with oropharyngeal cancer under an institution review board-approved protocol. We provided the scans to 26 radiation oncologists from 7 international cancer centers that participated in this delineation study. We also provide the patients' clinical history and physical examination findings, along with a medical photographic image and radiologic results. We used both the Simultaneous Truth and Performance Level Estimation algorithm and pair-wise comparisons of the contours, using overlap/distance metrics. Lastly, to assess experience and CTV delineation institutional practices, we had participants complete a brief questionnaire.Large variability was measured between observers' delineations for GTVs and CTVs. The mean Dice similarity coefficient values across all physicians' delineations for GTVp, GTVn, CTVp, and CTVn were 0.77, 0.67, 0.77, and 0.69, respectively, for Simultaneous Truth and Performance Level Estimation algorithm comparison, and 0.67, 0.60, 0.67, and 0.58, respectively, for pair-wise analysis. Normal tissue contours were defined more consistently when considering overlap/distance metrics. The median radiation oncology clinical experience was 7 years. The median experience delineating on magnetic resonance imaging was 3.5 years. The GTV-to-CTV margin used was 10 mm for 6 of 7 participant institutions. One institution used 8 mm, and 3 participants (from 3 different institutions) used a margin of 5 mm.The data from this study suggests that appropriate guidelines, contouring quality assurance sessions, and training are still needed for the adoption of magnetic resonance-based treatment planning for head and neck cancers. Such efforts should play a critical role in reducing delineation variation and ensure standardization of target design across clinical practices.

Objective: To assess the feasibility of the clinical use of 3 Tesla and 7 Tesla Magnetic Resonance Imaging for early (cT1) glottic carcinoma, including structural assessment of technical image quality and visibility of the tumor; and if feasible, to correlate MRI findings to routine diagnostics. Methods: Prospective feasibility study. Twenty patients with primary clinical T1 glottic carcinoma underwent both routine clinical staging and CT. In addition, a 3 T and 7 T MRI protocol, developed for small laryngeal lesions, was performed in a 4-point immobilization mask, using dedicated surface coils. Afterwards, routine endoscopic direct suspension laryngoscopy under general anaesthesia was performed. Results: Only 2 of 7 (29%) of 7 T MRI scans were rated as moderate to good technical image quality. After exclusion of three patients with only mild to moderate dysplasia at the time of MRI, 13 of 17 (76%) of 3 T MRIs were of adequate technical image quality. Tumor visualization was adequate in 8 of 13 (62%) of patients with invasive squamous cell carcinomas. With exclusion of the four MRIs with motion artefacts, the tumor and its boundaries could be adequately seen in 8 of 9 (89%) patients with squamous cell carcinoma versus only one in four (25%) of patients with carcinoma in situ lesions. Conclusions: 7 Tesla MRI was considered not feasible. 3 Tesla MRI, with adequate patient selection, namely clinical exclusion of patients with a history of claustrophobia and inclusion of only histologically proven invasive squamous cell carcinoma, can be feasible. Especially with further improvement of MR image quality. Level of Evidence: 2B, prospective diagnostic study.

Objective: In early glottic cancer, accurate assessment of tumor extension, including depth infiltration, is of great importance for both staging, therapeutic approach and systematic comparison of data. Our goal was to assess the diagnostic value of MRI in pre-therapeutic staging of primary early stage (T1 and T2) glottic carcinoma. Study design: Systematic review of literature. Methods: We conducted a systematic search in Pubmed, Embase, and Scopus up to September 23, 2016. Included studies were selected and critically appraised for relevance and validity. Results: Seven out of 938 unique articles were selected, including 64 cases. MRI over-staged 6% and under-staged 13% of cT1 and cT2 tumors. However, available data is heterogeneous, very limited and mainly based on subanalysis of a small amount of patients. Reported MRI protocols appear to be suboptimal for small laryngeal lesions. Diagnostic value of MRI for subtle depth infiltration or laryngeal anatomical subsites (eg, laryngeal ventricle, vocal cord, etc.) could not be assessed. Conclusions: More studies are needed to assess the diagnostic value of MRI for small glottic tumors.

Objective: Staging of laryngeal cancer largely depends on cartilage invasion. Presence of cartilage invasion affects treatment choice and prognosis. On MRI and contrast-enhanced CT (CECT) it may be challenging to differentiate cartilage invasion from inflammation. The purpose of this study is to compare the diagnostic properties of dynamic contrast-enhanced CT (DCECT) and CECT for visual detection of cartilage invasion in laryngeal cancer. Study Design: Prospective cohort study. Methods: Patients with T3 or T4 laryngeal squamous cell carcinoma treated with total laryngectomy were evaluated using 0.625 mm slice CT. DCECT derived permeability and blood volume maps and CECT images were visually evaluated for the presence of invasion of the cartilaginous T-stage subsites of laryngeal cancer, by detecting continuity with the tumor-bulk of increased permeability, increased blood volume, and enhancement. Histological evaluation of the surgical total laryngectomy specimen served as the gold standard. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated and compared using the McNemar and Chi-squared test. Results: From 14 included patients, a total of 462 subsites were available for T-stage analysis, of which 84 were cartilage. The median time between CT imaging and total laryngectomy was 1 day (range 1-34 days). There was no significant difference in the detection of cartilage invasion between DCECT and CECT. The sensitivity of CECT was better for all subsites combined (0.85 vs. 0.75; p