Helmuth Goepfert, MD

The paper by Mendenhall et al addresses a very debatable issue, ie, the influence of nodal stage on local control for head and neck carcinomas treated by radiotherapy. The paper is well written and appropriately referenced, and the authors fairly conclude that, based on currently available data, nodal stage has no clear impact on the probability of primary local control after radiotherapy.

Dr. Piccirillo presents an interesting concept. Although the knowledge that comorbidity and severity of symptoms have a bearing on the prognosis of a patient with cancer is not new, the attempt to measure this influence and include it into a reproducible staging system is commendable.