Author:
Beckham Thomas H.,Leeman Jonathan E.,Xie Peng,Li Xiaolin,Goldman Debra A.,Zhang Zhigang,Sherman Eric,McBride Sean,Riaz Nadeem,Lee Nancy,Tsai C. Jillian
Abstract
Abstract
Background
Our objective was to evaluate the outcomes of metastatic head and neck squamous cell carcinoma (HNSCC) by disease burden with an emphasis on metastasis-directed therapy (MDT) in patients with limited metastatic disease burden.
Methods
In total, 186 patients who developed metastatic disease after definitive therapy for HNSCC were included. Clinically and radiographically apparent metastases were enumerated. Kaplan–Meier methods were used to estimate survival. Cox regression was used to assess the association between clinical variables.
Results
Patients with a single metastasis had a 5-year overall survival (OS) of 35% (95% CI 16–54%) in contrast to patients with multiple metastases with a 5-year OS of 4% (95% CI 2–9%). Thirty patients (16.1%) underwent MDT. On multivariable analysis, oral cavity or sinonasal primary (HR 2.22 95% CI 1.16–4.25, p = 0.015; HR 4.88, 95% CI 1.10–21.70, p = 0.037, respectively) were associated with higher risk of death, whereas receipt of MDT (HR 0.36, 95% CI 0.17–0.74, p = 0.006) was associated with lower hazard of death. Median subsequent metastasis-free survival and 5-year survival after MDT (n = 30) were estimated at 26.4 months (95% CI: 9.8–54.0) and 31%, (95% CI: 15–48%).
Conclusions
HNSCC patients with limited metastatic disease may derive significant benefit from MDT. Prospective trials evaluating MDT in HNSCC are warranted.
Publisher
Springer Science and Business Media LLC
Reference25 articles.
1. Leeman, J. E., Li, J.-G., Pei, X., Venigalla, P., Zumsteg, Z. S., Katsoulakis, E. et al. Patterns of treatment failure and postrecurrence outcomes among patients with locally advanced head and neck squamous cell carcinoma after chemoradiotherapy using modern radiation techniques. JAMA Oncol. 3, 1487–1494 (2017).
2. Tiwana, M. S., Wu, J., Hay, J., Wong, F., Cheung, W. & Olson, R. A. 25 year survival outcomes for squamous cell carcinomas of the head and neck: population-based outcomes from a Canadian province. Oral Oncol. 50, 651–656 (2014).
3. Pignon, J.-P., le Maître, A., Maillard, E. & Bourhis, J., MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 92, 4–14 (2009).
4. Hellman, S. & Weichselbaum, R. R. Oligometastases. J. Clin. Oncol. 13, 8–10 (1995).
5. Weichselbaum, R. R. The 46th David A. Karnofsky memorial award lecture: oligometastasis-from conception to treatment. J. Clin. Oncol. 36, 3240–3250 (2018).
Cited by
35 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献