Treatment outcomes of T4 locally advanced head and neck cancers with soft tissue invasion or bone and cartilage invasion.

Purpose/Objective(s): T4 locally advanced squamous cell cancers of the head and neck (SCCHN) with bone and cartilage invasion (BCI) traditionally have been treated with resection followed up with chemoradiotherapy (CRT). Because the organ preservation trials, more patients with BCI, as well as those with soft tissue invasion (STI), have been treated with definitive CRT. This is a review of our experience. Materials/Methods: We performed a retrospective review of patients who under-went definitive CRT or radical resection followed up with postoperative CRT for T4N0-3M0 locally advanced SCCHN. We analyzed outcomes based on STI/BCI and types of treatment. Radiotherapy doses ranged from 59.4 to 72 Gy. Concurrent chemotherapy was platinum based in all CRT patients. Results: From 1995 to 2006 101 patients with locally advanced SCCHN were treated definitively. Of these, 51 had STI and 50 had BCI. Of the 51 patients with STI, 42 were treated with CRT, 5 patients were treated with resection followed by CRT, and 4 patients were treated with radiotherapy alone. Of the 50 patients with BCI, 26 patients were treated with CRT, 20 patients were treated with radical resection followed by radiotherapy or CRT, and 4 patients were treated with radiotherapy alone. Five-year local-regional control was 51% and 43% for STI and BCI patients treated with CRT, respectively, and 44% for BCI treated with radical resection. Five-year overall survival was 23%, 51%, and 28% for STI treated with CRT, BCI treated with CRT, and BCI treated with radical resection. Outcomes were not statistically different between these groups. Conclusions: This study suggests similar outcomes for CRT or resection followed up with chemoradiotherapy for patients with locally advanced SCCHN with BCI. Concurrent CRT may be viable alternative to upfront resection in these patients. Further studies should be performed to validate these provocative findings.