Oncological Outcomes after Pulmonary Metastasectomy for Head and Neck Squamous-Cell Carcinoma and Adenoid Cystic Carcinoma

Abstract

<b><i>Introduction:</i></b> Pulmonary metastatic head and neck cancer has a poor prognosis. Pulmonary metastasectomy has been performed but only in carefully selected patients. The aim of this study was to examine the clinical characteristics and oncological follow-up of patients who underwent pulmonary metastasectomy. <b><i>Methods:</i></b> Data of 54 patients with squamous-cell carcinoma (SCC) or adenoid cystic carcinoma (ACC) who underwent metastasectomy between 2003 and 2019 at two tertiary referral centers were retrospectively reviewed. <b><i>Results:</i></b> The 3-year and 5-year disease-free survival rates after metastasectomy were 49.9% and 39.9% for SCC and 38.9% and 32.4% for ACC, respectively. Univariate analysis revealed that a disease-free interval (DFI) less than 14 months and R1 resection (hazard ratio [HR] [95% confidence interval]: 2.95 [0.77–5.62], 4.64 [0.99–21.65], respectively) were risk factors for recurrence in SCC and that a high T stage (HR: 5.24 [1.22–22.58]) was a risk factor in ACC. In SCC, a DFI less than 14 months and R1 resection (hazard ratio: 6.35 [1.36–29.54], 12.79 [1.53–106.95], respectively) were risk factors in a multivariate analysis. <b><i>Conclusion:</i></b> Pulmonary metastasectomy had a fair effect on head and neck SCC and ACC, and the prognosis was better in SCC patients with a DFI greater than 14 months.

Approaches to the Management of Metastatic Adenoid Cystic Carcinoma

“…By 8 years, the DFS dropped to 0% in this cohort, demonstrating difficulty in achieving a permanent oncologic cure through PM alone. While these percentages are substantially lower than the other studies analyzed here, it is important to note that the authors only reported DFS and not OS, and it is likely that many of these patients survived significant periods of time after the appearance of their second recurrence, given the often slowly progressive nature of ACC [ 135 ].…”

“…Most recently, a 2022 study which included 18 ACC patients reported 1-, 3-, and 5-year post-PM disease-free survival (DFS) rates of 88.9%, 38.9%, and 32.4%, respectively [ 135 ]. By 8 years, the DFS dropped to 0% in this cohort, demonstrating difficulty in achieving a permanent oncologic cure through PM alone.…”