Oligometastatic head and neck cancer: Which patients benefit from radical local treatment of all tumour sites?
Head and neck cancer
Local treatment
Oligometastatic disease
Radiotherapy
SBRT
Journal
Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111
Informations de publication
Date de publication:
31 Mar 2021
31 Mar 2021
Historique:
received:
27
12
2020
accepted:
17
03
2021
entrez:
1
4
2021
pubmed:
2
4
2021
medline:
19
11
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 33789725
doi: 10.1186/s13014-021-01790-w
pii: 10.1186/s13014-021-01790-w
pmc: PMC8011153
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
62Références
J Clin Oncol. 2018 Feb 10;36(5):446-453
pubmed: 29240541
Eur J Cancer. 2009 Jan;45(2):228-47
pubmed: 19097774
Head Neck. 2019 Jul;41(7):2309-2314
pubmed: 30788878
Magn Reson Imaging. 2012 Nov;30(9):1323-41
pubmed: 22770690
Nat Rev Clin Oncol. 2017 Jun;14(6):365-379
pubmed: 28094262
World J Urol. 2019 Dec;37(12):2631-2637
pubmed: 30859273
N Engl J Med. 2008 Sep 11;359(11):1116-27
pubmed: 18784101
Lancet. 2019 Nov 23;394(10212):1915-1928
pubmed: 31679945
Lancet. 2019 May 18;393(10185):2051-2058
pubmed: 30982687
Head Neck. 2020 Aug;42(8):1939-1953
pubmed: 32129548
Med Oncol. 2018 Aug 4;35(9):121
pubmed: 30076479
J Clin Oncol. 2019 Jun 20;37(18):1558-1565
pubmed: 31067138
Lancet Oncol. 2020 Jan;21(1):e18-e28
pubmed: 31908301
Strahlenther Onkol. 2020 Nov;196(11):1018-1033
pubmed: 32519025
J Clin Oncol. 1995 Jan;13(1):8-10
pubmed: 7799047
Oral Oncol. 2019 Jun;93:1-7
pubmed: 31109688
Cancer Res. 2017 Nov 1;77(21):e104-e107
pubmed: 29092951
Eur Arch Otorhinolaryngol. 2018 May;275(5):1239-1247
pubmed: 29520497
JAMA Oncol. 2018 Jan 11;4(1):e173501
pubmed: 28973074
Strahlenther Onkol. 2018 Jun;194(6):509-519
pubmed: 29500551
Strahlenther Onkol. 2020 Apr;196(4):325-333
pubmed: 31605163
Radiother Oncol. 2020 Jul;148:157-166
pubmed: 32388150