title: Prognostic significance of bone or cartilage invasion of locally advanced head and neck cancers.
abstract: OBJECTIVE
  Locally advanced squamous cell cancers of the head and neck with bone and cartilage invasion (BCI) traditionally have been treated with resection followed up with radiotherapy or less commonly definitive chemoradiotherapy (CRT). However, it is unclear whether bone or cartilage invasion confers a worse prognosis in comparison with each other.
  
  
  METHODS
  T4N0-3M0 squamous cell cancers of the head and neck patients underwent CRT or radical resection followed up with postoperative CRT. Oral cavity, oropharynx, laryngeal and hypopharyngeal squamous cell cancers were included. Radiotherapy ranged from 59.4 to 72 Gy. Concurrent chemotherapy was platinum based.
  
  
  RESULTS
  Forty-six patients with BCI were treated. When treated with CRT, 5-year local control was 55% and 43% for BCI, respectively (P = 0.23). Five-year overall survival for these patients was 54% and 29% for BCI, respectively (P = 0.99). When treated with upfront resection, 5-year local control was not significantly different (P = 0.60) nor was 5-year overall survival (P = 0.15).
  
  
  CONCLUSIONS
  This study suggests similar outcomes between patients with bone or cartilage invasion treated with upfront CRT or resection followed by CRT. Concurrent CRT may be viable alternative to resection in patients with either bone or cartilage invasion.
authors.affiliation: Department of Radiation Oncology, University of California Davis, Sacramento, 95817, USA. ly.do@ucdmc.ucdavis.edu
authors.forename: Ly
authors.initials: L
authors.lastname: Do
authors.forename: Nisar
authors.initials: N
authors.lastname: Syed
authors.forename: Ajmel
authors.initials: A
authors.lastname: Puthawala
authors.forename: Samar
authors.initials: S
authors.lastname: Azawi
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.forename: Nayana
authors.initials: N
authors.lastname: Vora
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D002356:Cartilage / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009372:Neoplasms, Connective Tissue / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome