title: Prognostic significance of thyroid or cricoid cartilage invasion in laryngeal or hypopharyngeal cancer treated with organ preserving strategies.
abstract: BACKGROUND
  The utility of definitive radiotherapy (RT) for locoregionally advanced squamous cell carcinoma (SCC) of the larynx or hypopharynx in the setting of thyroid or cricoid cartilage invasion (TCCI) is controversial. A retrospective review of our experience was performed.
  
  
  METHODS
  Our institutional database of patients with SCC of the head and neck treated with radiotherapy (90% received concurrent systemic therapy) between 1995 and 2009 was queried. We identified 87 patients with T3-4 laryngeal or T4 hypopharyngeal cancer for whom initial head and neck imaging was available for review. Imaging of all patients was reviewed by a single radiologist specializing in neuroradiology. The presence and extent of TCCI was determined and used for stratification.
  
  
  RESULTS
  Median follow-up was 34 months. TCCI was found in 25 (29%) patients, eight limited to the inner cortex and another 17 involving both cortices. Local control (LC) was not significantly affected by TCCI limited to the inner cortex. However, TCCI involving both cortices was correlated with diminished LC at 2 years compared to the group of patients with no or minor invasion (55% vs. 81%, p=0.045). However, TCCI involving both cortices was not associated with significantly reduced rates of survival with a functional larynx, or overall survival (OS).
  
  
  CONCLUSIONS
  Our results suggest that the rate of LC of T3-4 laryngeal or T4 hypopharyngeal SCC treated with definitive RT is not affected by TCCI of the inner cortex. Although decreased LC was significantly associated with TCCI involving both cortices, this factor did not appear to result in reduced rates of survival with a functional larynx or OS. Therefore, organ preservation may remain an option in these patients.
authors.affiliation: Department of Radiation Oncology, University of Alabama at Birmingham, Hazelrig-Salter Radiation Oncology Center, 1700 6th Avenue South, Birmingham, AL 35249-6832, USA.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Wagner
authors.forename: Joel K
authors.initials: JK
authors.lastname: Curé
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Caudell
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Spencer
authors.forename: Lisle M
authors.initials: LM
authors.lastname: Nabell
authors.forename: William R
authors.initials: WR
authors.lastname: Carroll
authors.forename: James A
authors.initials: JA
authors.lastname: Bonner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D003413:Cricoid Cartilage / Q000473:pathology*; D016208:Databases, Factual; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D013957:Thyroid Cartilage / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000401:mortality / Q000556:secondary*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome