Survival outcome of head and neck cancer patients with distant metastases: Relevance of initial presentation and treatment strategy

Introduction:

Up to 10% of all patients with squamous cell carcinoma of the head and neck (HNSCC) present with distant metastatic disease at time of diagnosis. Furthermore, many patients suffer from distant tumor spread during the course of disease either with or without prior or simultaneous locoregional failure. Within this patient cohort different therapeutic options are available such as systemic or local approaches (surgery/radiation). There is a lack of data on the best survival outcome of these patients depending on the timepoint of distant metastases and selected treatment.

Methods:

Retrospective data analysis of HNSCC patients diagnosed with distant metastasis from 2011 – 2016. Included are patients with primarily distant metastatic disease and those diagnosed with a metastasis after definitive treatment. Differentiation was made between metastasis localization and therapy concept. Survival (OS and PFS) was investigated by Kaplan-Meier method.

Results:

Eighty-six patients were included, of which 27 were primarily metastatic. Twenty-six patients developed exclusively distant metastasis during the course of the disease whereas 37 had also a locoregional recurrence. The lung was the most common location (55.8%) of a metastasis. Systemic therapy was performed in 57% of our patients. There was no significant difference in median survival between the tumor entities, but the median survival for single metastasis was 12 months versus 5 months for multiple metastasis (p-value: < 0.001).

Conclusions:

A significant difference in median survival is evident in the number of metastases, mainly with lung involvement. Larger case numbers are needed to assess whether systemic therapy continues to be the treatment of choice or if local therapies may improve prognosis.

Publication History

Publication Date:
23 April 2019 (online)