Oligometastatic head and neck cancer: Which patients benefit from radical local treatment of all tumour sites?

Abstract

Background There is a large lack of evidence for optimal treatment in oligometastatic head and neck cancer and it is especially unclear which patients benefit from radical local treatment of all tumour sites. Methods 40 patients with newly diagnosed oligometastatic head and neck cancer received radical local treatment of all tumour sites from 14.02.2008 to 24.08.2018. Primary endpoint was overall survival. Time to occurrence of new distant metastases and local control were evaluated as secondary endpoints as well as prognostic factors in univariate und multivariate Cox’s regression analysis. To investigate the impact of total tumour volume on survival, all tumour sites were segmented on baseline imaging. Results Radical local treatment included radiotherapy in 90% of patients, surgery in 25% and radiofrequency ablation in 3%. Median overall survival from first diagnosis of oligometastatic disease was 23.0 months, 2-year survival was 48%, 3-year survival was 37%, 4-year survival was 24% and 5-year survival was 16%. Median time to occurrence of new distant metastases was 11.6 months with freedom from new metastases showing a tail pattern after 3 years of follow-up (22% at 3, 4- and 5-years post-treatment). In multivariate analysis, better ECOG status, absence of bone and brain metastases and lower total tumour volume were significantly associated with improved survival, whereas the number of metastases and involved organ sites was not. Conclusions Radical local treatment in oligometastatic head and neck cancer shows promising outcomes and needs to be further pursued. Patients with good performance status, absence of brain and bone metastases and low total tumour volume were identified as optimal candidates for radical local treatment in oligometastatic head and neck cancer and should be considered for selection in future prospective trials.

Oropharyngeal squamous cell carcinoma: Prognostic factors for development of distant metastases and oncological outcomes

“…These findings show the possibility of metastasis-directed therapy, which means performing radical approaches on pulmonary lesions, such as surgery or stereotactic radiation, by improving the survival of these patients. 31,32 In our study, the experience of an LRr did not correlate with statistically significant results in terms of OS in the DM group (p = 0.16), but only in the NDM ones (p < 0.0001). However, in the DM group, we pointed out a trend showing worse OS for patients with positiveness for p16 when compared with p16À ones, regardless LRr development.…”

“…In our study, 49% (18 out of 37) of patients with lung metastases had only one or two metastatic lesions. These findings show the possibility of metastasis‐directed therapy, which means performing radical approaches on pulmonary lesions, such as surgery or stereotactic radiation, by improving the survival of these patients 31,32 …”

Is Oligometastatic Cancer Curable? A Survey of Oncologist Perspectives, Decision Making, and Communication

“…The nontrivial proportion of patients with OMD progress despite treatment may create an availability bias that affects oncologists’ views on OMD curability. 18 , 19 …”

Oligometastatic Head and Neck Cancer: Challenges and Perspectives

“…Mounting evidence has stimulated official guidelines from international oncological associations such as the European Society for Therapeutic Radiology and Oncology (ESTRO) and the American Society for Radiation Oncology (ASTRO) to recognize local ablative therapy as an option for patients with oligometastatic disease [ 23 ]. In HNSCC specifically, the current evidence supporting the role of local ablation of oligometastatic disease is limited to a small number of retrospective studies [ 24 , 25 , 26 , 27 , 28 ]. The two primary local ablation modalities for curative-intent of metastasis include surgery and radiotherapy, specifically stereotactic ablative radiotherapy (SABR).…”

“…Poor prognostic factors in this cohort included the presence of cervical lymph node metastasis at initial diagnosis, oral cavity primary site, incomplete pulmonary resection, and the presence of multiple pulmonary nodules. Several small subsequent retrospective studies (sample size ranged from 27 to 82 patients) of oligometastatic patients from HNSCC (58–100% involved the lungs) treated with surgery or SABR have reported overall survival rates as high as 75% at 1-year and 40–50% at 5-years [ 24 , 25 , 27 , 28 , 37 ]. Median overall survival was around 2 years in most series, but reached 47 months in some reports with exclusive lung metastasis [ 28 ].…”