title: T4 squamous cell carcinoma of the oral tongue without mandibular involvement: surgery or chemoradiotherapy?
abstract: OBJECTIVE
  To investigate disease control and functional outcomes in patients with T4 squamous cell carcinoma of the oral tongue who had undergone surgery or definitive chemoradiotherapy.
  
  
  METHODS
  Records of all consecutive patients with T4 squamous cell carcinoma of the oral tongue treated radically between 1999 and 2010 at the Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, were retrospectively reviewed.
  
  
  RESULTS
  Of 31 patients, 19 underwent surgery and 12 underwent definitive chemoradiotherapy. There were no significant differences between cohorts in terms of age, nodal involvement, or performance status. All patients had T4 disease on the basis of extrinsic muscle invasion; none had bone invasion. Disease outcomes at 5 years after surgery or chemoradiotherapy were not significantly different, including local control (61% vs 70%), progression-free rate (56% vs 55%), and overall survival (27% vs 40%). A higher proportion of patients in the chemoradiotherapy group had only mild impairment of speech and swallowing.
  
  
  CONCLUSIONS
  Definitive chemoradiotherapy may be a reasonable alternative to surgery for patients with T4 squamous cell carcinoma of the oral tongue without bony invasion.
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Electronic address: lachlan.mcdowell@petermac.org.
authors.forename: Lachlan
authors.initials: L
authors.lastname: McDowell
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Marnie
authors.initials: M
authors.lastname: Collins
authors.affiliation: Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kleid
authors.affiliation: Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Rischin
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Corry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures; D012189:Retrospective Studies; D015996:Survival Rate; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome