Abstract
BackgroundThere 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.Methods40 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.ResultsRadical 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.ConclusionsRadical 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.
Highlights
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
Oligometastatic disease remains poorly defined and the most widely recognized criterion of oligometastatic disease is the ability to safely apply local treatment to all tumour sites, which is largely because of a great lack of scientific studies to base any additional criteria upon. As such it is currently still largely unclear, which patients should receive radical local treatment of all metastatic sites in addition to or instead of systemic treatment for metastatic disease. This is especially true in metastatic head and neck cancers, in which the significance and potential benefit of radical local treatment remains largely unexplored to this date and only very few and small series have been published so far
We explore potential prognosticators including tumour volume-based metrics that have been implicated in the definition of oligometastatic disease to further elucidate which patients with metastatic head and neck cancer will benefit the most from radical local treatment of all tumour sites
Summary
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. The wellrecognized Phase II trial by Gomez et al, reported significantly improved overall survival (41.2 vs 17 months) as well as decreased occurrence of new distant lesions in oligometastatic NSCLC patients [5] Encouraged by such promising results, scientific societies like the EORTC, ESTRO and ASTRO have put forth diagnostic criteria as well as classification proposals for oligometastatic disease in recent months [1, 2]. Despite these efforts, oligometastatic disease remains poorly defined and the most widely recognized criterion of oligometastatic disease is the ability to safely apply local treatment to all tumour sites, which is largely because of a great lack of scientific studies to base any additional criteria upon. Investigation of the oligometastatic paradigm is challenging in metastatic head and neck cancers, any resulting contribution to current systemic treatment options for patients with metastatic disease could be of particular value
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