Combined high‐intensity local treatment and systemic therapy in metastatic head and neck squamous cell carcinoma: An analysis of the National Cancer Data Base

Abstract

BACKGROUND There is increasing evidence that primary tumor ablation can improve survival for some cancer patients with distant metastases. This may be particularly applicable to head and neck squamous cell carcinoma (HNSCC) because of its tropism for locoregional progression. METHODS This study included patients with metastatic HNSCC undergoing systemic therapy identified in the National Cancer Data Base. High-intensity local treatment was defined as radiation doses ≥ 60 Gy or oncologic resection of the primary tumor. Multivariate Cox regression, propensity score matching, landmark analysis, and subgroup analysis were performed to account for imbalances in covariates, including adjustments for the number and location of metastatic sites in the subset of patients with this information available. RESULTS In all, 3269 patients were included (median follow-up, 51.5 months). Patients undergoing systemic therapy with local treatment had improved survival in comparison with patients receiving systemic therapy alone in propensity score-matched cohorts (2-year overall survival, 34.2% vs 20.6%; P < .001). Improved survival was associated only with patients receiving high-intensity local treatment, whereas those receiving lower-intensity local treatment had survival similar to that of patients receiving systemic therapy without local treatment. The impact of high-intensity local therapy was time-dependent, with a stronger impact within the first 6 months after the diagnosis (adjusted hazard ratio [AHR], 0.255; 95% confidence interval [CI], 0.210–0.309; P < .001) in comparison with more than 6 months after the diagnosis (AHR, 0.622; 95% CI, 0.561–0.689; P < .001) in the multivariate analysis. A benefit was seen in all subgroups, in landmark analyses of 1-, 2-, and 3-year survivors, and when adjusting for the number and location of metastatic sites. CONCLUSIONS Aggressive local treatment warrants prospective evaluation for select patients with metastatic HNSCC.

Radiation therapy for patients with newly diagnosed metastatic head and neck squamous cell carcinoma

“…Furthermore, subgroup analysis demonstrated that the benefit for the addition of RT was consistent across all subgroups including the different primary tumor sites of the head and neck. A recent analysis of the NCDB demonstrated that intensification of treatment with either surgical resection or definitive RT was associated with improved survival and supports our results . In this study, survival outcomes were similar to our findings favoring the local treatment cohort.…”

“…As a biologically effective dose (BED) of at least 72 Gy 10 is needed to achieve long‐term local control, we compared the effect of delivering BED doses of 72 Gy 10 or higher on OS to that of lower doses. The BED of 72 Gy 10 was chosen a priori based on clinical data demonstrating the need for these doses (approximately 60 Gy in 30 fractions) to achieve adequate local control. Patients were excluded from the BED analysis if they had nonsensical doses such as doses >200 Gy or if they did not have a RT dose specified.…”

Role of concurrent chemoradiotherapy and stereotactic body radiation treatment for palliation of previously untreated head and neck cancers

“…A recent analysis of the National Cancer Data Base suggested that the aggressive treatment of patients with metastatic head and neck squamous cell carcinoma using combined high‐intensity local treatment (radiation dose >60 Gy or oncologic resection of the tumor) had improved survival in comparison with patients receiving systemic therapy alone 9 . The local therapy given within the first 6 months from diagnosis had a stronger impact on survival.…”

“…7 had improved survival in comparison with patients receiving systemic therapy alone. 9 The local therapy given within the first 6 months from diagnosis had a stronger impact on survival.…”

Single community-based institutional series of stereotactic body radiation therapy (SBRT) for treatment of liver metastases

“…Further, some have suggested that, analogous to surgery, advanced radiotherapy techniques performed at low-volume centers result in inferior outcomes and in head and neck cancer was even shown to negatively affect overall survival of patients (23). Others have recently asserted that certain cancers should be preferentially treated at academic centers because treatment at community hospitals was found to be associated with an increased risk of death (24)(25)(26)(27).…”