BACKGROUND: Invasion of bony or cartilaginous structures by advanced upper aerodigestive tract @entity5 has been considered an indication for surgery on the basis of historic experience of poor responsiveness to radiation therapy. At University of Tennessee-Memphis, @entity1 with advanced @entity135 have been treated on a protocol of concomitant intra-arterial (targeted) @entity900 and conventional radiation therapy. OBJECTIVE: To compare the efficacy, in terms of disease control and survival, of this protocol in @entity1 with T4 @entity1544 and @entity3 (group 1; n = 45) vs those with T4 disease but no bone or cartilage involvement (group 2; n = 90). DESIGN: Subset analysis of protocol database and retrospective chart review. METHODS: Treatment consisted of 4 weekly intra-arterial infusions of @entity900 (150 mg/m(2) per week), with simultaneous systemic neutralization by intravenous @entity15451 (9 mg/m(2)), and concurrent radiation therapy at 180 rad (1.8 Gy) or 200 rad (2 Gy) per fraction to a planned total of 6600 to 7400 rad (66-74 Gy) to the primary site or overt nodal disease. Presence of bone or cartilage invasion was established by review of @entity5 diagrams of clinical findings and computed tomography or magnetic resonance imaging reports. RESULTS: Of 135 @entity1 who had T4 disease and a minimum follow-up of 9 months (median, 40 months), 45 had clinical or radiologic evidence of bone (n = 29: mandible, 12; maxilla, 9; sphenoid, 3; hyoid, 6) and/or cartilage (n = 18: thyroid, 16; cricoid, 4) invasion (some @entity1 had involvement of more than 1 site). The rate of complete response in group 1 (66.7%) was not significantly different from that in group 2 (71.1%) (chi(2) test, P = .79). The 2-year overall actuarial survival for group 1 (46.3%; 95% confidence interval, 30.3%-62.3%) was not significantly different (generalized Wilcoxon test, P = .36) from that of group 2 (36.9%; 95% confidence interval, 25.5%-48.4%). A marked trend was noted for higher response rates in cases of cartilage invasion (81.2%) than in those with bone invasion (58.6%) (P = .15). CONCLUSION: Equivalent efficacy of treatment in the 2 groups suggests that targeted chemoradiation can be a definitive therapeutic option in @entity1 with advanced @entity135 invading bony or cartilaginous structures.

Bone or cartilage invasion by advanced XXXX : intra-arterial supradose @entity900 chemotherapy and concomitant radiotherapy for organ preservation.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity135 :: ('MESH:D006258', 'Disease') :: ['head and neck cancer'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'cancer'] @entity900 :: ('MESH:D002945', 'Chemical') :: ['cisplatin'] @entity1544 :: ('MESH:D018307', 'Disease') :: ['squamous cell cancers'] @entity15451 :: ('MESH:C017717', 'Chemical') :: ['sodium thiosulfate'] @entity3 :: ('MESH:D009362', 'Disease') :: ['invasion of bony or cartilaginous structures']
@entity135 :: (MESH:D006258,Disease) :: ['head and neck cancer']
