Bone metastases from head and neck malignancies: Prognostic factors and skeletal-related events

Abstract

BackgroundWe conducted a multicenter retrospective analysis to describe the characteristics, frequency of skeletal-related events (SREs), and prognosis of head and neck cancer (HNC) in patients with bone metastases (BM).Patients and methodsThe data of 192 HNC patients with BMs were collected. Analyses were conducted separately in 64 nasopharyngeal cancer (NPC) patients and in 128 non-NPC patients.ResultsSREs occurred in 34 (27%) non-NPC and in 6 (9%) NPC patients, respectively. Median overall survival (OS) was 25 and 6 months in NPC and non-NPC patients, respectively. Locoregional recurrence (hazard ratio [HR] 2.33, 95% confidence interval (CI) 1.1–4.93), synchronous BM (HR 0.25, 95% CI 0.59–0.71) and bone-directed therapies (BDT) (HR 0.26, 95% CI 0.10–0.68) were independent prognostic factors for OS in NPC patients. Combined bone radiotherapy (RT) and BDT in NPC patients obtained longer survival (38 months) than either therapy alone (25 months) or neither of these therapies (8 months).ConclusionsPatients with BMs from non-NPC have a poor prognosis and are at high risk of SREs. NPC patients with BMs are at relatively low risk of SREs. BDT may potentially improve survival, particularly when combined with bone RT. This last finding deserves prospective confirmation.

High Prevalence and Early Occurrence of Skeletal Complications in EGFR Mutated NSCLC Patients With Bone Metastases

“…This proportion is similar to that reported in the above mentioned Italian series of bone metastatic lung cancer patients (18), 94.3% of them treated with chemotherapy. Also, the proportion of major SREs (28%), observed in the present study, is similar to that reported in the mentioned series as well as in other published bone metastatic patient series with different primary histologies (19)(20)(21). The outcome of patients with EGFR mutated lung cancer with bone metastases have been evaluated in six published papers in which the SRE frequency was 0% in only one paper (22), while ranged between 20 and 51% in the remaining five papers (13-17) ( Table 4).…”

The Role of Palliative Radiotherapy in the Treatment of Spinal Bone Metastases from Head and Neck Tumors—A Multicenter Analysis of a Rare Event

“…While pathological fractures of SBM were commonly detected before the initiation of RT, treatment did only rarely result in increasing fracture rates and/or new metastatic spinal cord compression with consecutive cross-sectional symptoms. In sum, a total of seven patients (11%) developed serious adverse advents after RT, which is in line with the results of other study groups [32,33].…”

“…Interestingly, bisphosphonate administration did not lead to increased stabilization rates after palliative RT in our cohort. In contrast, Grisanti and colleagues [33] showed that the combination of RT and bone-modifying treatment (bisphosphonates and denosumab) resulted in significantly improved survival in nasopharyngeal carcinoma patients, when compared to each treatment alone. Furthermore, the authors could not detect severe adverse reactions following bone-modifying treatment and concluded that the combination of bone-modifying treatment and RT may be an appropriate approach for bone metastases of nasopharyngeal carcinoma patients.…”

Association of circulating protein biomarkers with clinical outcomes of durvalumab in head and neck squamous cell carcinoma

“…Osteocalcin is a versatile, bone-derived, immunostimulatory hormone, 24 and bone is one of the most common sites of distant metastases from HNSCC. 25 Therefore, using osteocalcin as a marker, we sought to determine whether bone metastasis underlies the relationship between osteocalcin and OS. Thirty-five patients demonstrated evidence of bone metastases in our dataset, and Cox modeling indicated that the survival association of osteocalcin was independent of bone metastasis.…”