Local therapies for liver metastases of rare head and neck cancers: A monoinstitutional case series

Abstract

Introduction: Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are established procedures for treating hepatocellular cancer and selected malignancies with liver metastasis. The aim of this study is to describe a monoinstitutional case series of local approaches in patients with liver metastases from rare head and neck cancers (HNCs). Methods: This is a retrospective series of adult patients with HNC treated with liver locoregional approaches (TACE or RFA) at our institution from 2007 to 2018. In case of chemoembolization, the preferred chemotherapeutic drug was doxorubicin. Response according to RECIST (Response Evaluation Criteria in Solid Tumors) was assessed with contrast-enhanced computed tomography scans. Results: Thirty-four patients were treated (20 men, median age 58 years) with TACE (27), transarterial embolization (2), or RFA (7). Primary tumours were salivary gland (21), thyroid (6), nasopharyngeal (5), and sinonasal cancers (2). Seventeen patients (50%) had a single metastatic liver nodule; 70% of the remaining 17 patients had at least three liver metastases. The median diameter of the metastatic liver mass undergoing treatment was 39 mm (range 11–100 mm). Median follow-up was 27.6 months. Response rate was 35% (3% complete, 32% partial response). Median progression-free survival and overall survival were 6.9 and 19.6 months, respectively. Treatment-related adverse events occurred in 59% of patients (21% grade ⩾ 3; no grade 5). Discussion: This retrospective case series demonstrates that locoregional radiologic approaches for rare HNCs with liver metastases are feasible. These procedures deserve further prospective studies before being considered safe and active in these malignancies where the availability of effective systemic treatments is lacking.

Salivary gland cancer: ESMO–European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up

“…For oligometastatic disease, locoregional treatments such as surgery, 71 , 72 , 73 radiofrequency ablation 74 or stereotactic RT 75 can be considered in selected cases, especially in AdCC. In one study, a prolonged disease-free interval (>36 months) and radical resection were the main prognostic factors in 109 patients with AdCC and lung metastases who underwent metastasectomy.…”

Interventional Radiology Approaches for Liver Metastases from Thyroid Cancer: A Case Series and Overview of the Literature

“…A subsequent manual crossreferencing was performed to find further pertinent studies. Table 2 summarizes current published reports about this topic [8,[11][12][13][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…In some of the published reports, TC patients with LMs have been included in larger cohorts of patients treated with LRTs for LM from other solid tumours (especially neuroendocrine tumours) or for primary hepatic malignancies [ 8 , 17 , 20 , 21 , 23 , 24 ]. In these heterogeneous cohorts, data regarding the subgroups of patients with TC were not analysed separately; hence, no definitive conclusion concerning their outcomes can be retrieved.…”

“…In the last decades, non-surgical loco-regional treatments (LRTs) including thermo-ablation techniques, such as radiofrequency ablation (RFA) or microwave ablation (MWA), and embolization techniques, such as trans-arterial embolization/chemoembolization (TAE/TACE), have been increasingly employed to treat both primary hepatic malignancy [6] and LMs from various types of cancer [7][8][9]. According to the ATA guidelines [10], image-guided LRTs can be performed to provide palliation or radical local tumour control in the oligo-metastatic setting; according to the specific needs of the patient, different treatment can be combined.…”

Immunotherapy in head and neck squamous cell carcinoma and rare head and neck malignancies

“…As a general approach, it might be helpful to distinguish between adenoid cystic carcinoma (ACC) and non-ACC. The former usually undergo a watchful-waiting strategy or from loco-regional procedures when oligometastatic or paucisymptomatic (e.g., lung metastasectomies [ 92 ] or liver local therapies [ 93 ]). Symptomatic R/M ACC or cases with a high disease burden can be treated with the multi-kinase inhibitor lenvatinib (ORR 11.5–15.6%, median PFS 9.1–17.5 months, median OS 27.5 months) [ 94 , 95 ].…”