Predicting factors for distant metastases in head and neck carcinomas: An analysis of 103 patients with locoregional control

Shingaki, Susumu; Suzuki, Ichirô; Kobayashi, Tadaharu; Nakajima, Tamio

doi:10.1016/s0278-2391(96)90535-2

Cited by 73 publications

(50 citation statements)

References 30 publications

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“…The site of the primary may influence the rate of DM, with reported ~ 75-80% 2-3y DM-free survival rates in localregionally advanced nasopharyngeal [16,18,21,29], sinonasal [9,13,22], hypopharyngeal [27] and laryngeal tumors [5], ~ 85-95% in oropharyngeal tumors [4,7,15], and ~ 90-95% in oral cavity cancer (OCC) [3][4][5][6]10], respectively. For local-regionally advanced hypopharyngeal tumors, 3y-DM free survival rates of as low as 30% are reported [8,17].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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Background and Purpose: Intensity modulated radiation therapy (IMRT) combined treatment approaches, surgical and radiodiagnostic advances, respectively, lead to improved local-regional control in head neck cancer (HNC). With increasing local-regional control, distant metastases (DM) become more meaningful. In some trials without concomitant chemotherapy, induction chemotherapy (IC) resulted in an absolute reduction of DM by ~10-15%. In order to define a more efficient selection of patients at risk for DM with respect to IC and M-staging, we analysed our patients treated by contemporary standards. Patients and Methods: Between 1/2002 to 12/2007, 409 HNC patients were treated with IMRT; 303/409 (74%) underwent definitive, 106 (26%) postoperative IMRT. The mean/median follow-up was 23/20 months (3-72). 70% tolerated 4-7, 9% 1-3 cycles of simultaneous cisplatin. Treatment followed a prospectively designed protocol. In a previous study with 172 HNC IMRT patients, gross tumor volume (GTV) was found the strongest predictor for local-regional control. In the current study, this criterion has been prospectively tested for DM. Numbers needed to treat were calculated for IC. Results: DM developed in 28/399 (7%) patients; 10 presented initially with DM (total 38/409). In 13/28 (46%), DM remained the only manifestation of disease. GTV was the strongest predictor for DM (p < 0.0001) of all tested. Only 4% of patients with GTV < 70 cc developed DM, vs. 25% (18/73) with > 70 cc; only 6 of them (6/73, 8%) developed isolated DM. Conclusion: GTV was the most significant predictor for DM, that could guide selective pre-treatment M-staging. The subgroup with isolated DM in the high risk group, that could benefit from IC, is small. (Table 1). Die Therapie folgte einem prospektiv festgelegten Protokoll. In einer früheren Studie mit 172 KHTPatienten mit definitiver IMRT wurde das "gross tumor volume" (GTV) als signifikantester Prädiktor für die Lokoregionalkontrolle nachgewiesen. In der hier präsentierten Studie wurde dasselbe volumetrische Staging-System getestet hinsichtlich dessen prä-diktiven Wert für DM, um eine allfällige IC wie auch die initiale Metastasensuche selektiver auf ein Hochrisikopatientensegment beschränken zu können. Ergebnisse: DM fanden sich bei 38/409 Patienten bzw. bei 28/399 mit initialem M0-Status (7%) (Abbildung 1, Tabelle 2); 10 Patienten hatten initial bereits DM. Bei nur 13/28 (46%) blieben DM die einzige Krankheitsmanifestation. Das GTV erwies sich als signifikantester aller getesteter Metastasenprädiktoren (p < 0,0001, Abbildung 2, Tabelle 3); nur 4% der Patienten mit einem GTV < 70 cc entwickelten DM, vs. 25% (18/73) mit GTV > 70 cc, von diesen nur 6 mit isolierter DM (6/73, 8%). IntroductionClinical implementation of intensity modulated radiation therapy (IMRT), together with combined treatment approaches in definitive and postoperative treatment settings, surgical and radio-diagnostic advances, respectively, lead to an encouraging improvement of the loco-regional control in head and neck cancer (HNC)...

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Section: Discussionmentioning

confidence: 99%

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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“…5 Less frequent metastases have also been described in long bones (femur, tibia, and ribs). 3 Retrospective studies of human head and neck SCC demonstrated that the most common site of distant metastasis is the lung, 6,10,11 and bone is the second 10 or fourth 6 most common site.…”

Section: Metastatic Oral Squamous Cell Carcinoma In a Montagu's Harrimentioning

confidence: 99%

Metastatic Oral Squamous Cell Carcinoma in a Montagu's Harrier (Circus Pigargus)

et al. 1999

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“…The development of skin metastasis is most closely related to the presence of two or more cervical metastases and or extracapsular spread of tumor in the cervical lymph nodes [9]. Skin metastases occur in 1-2% of all patients with squamous cell carcinoma (SCC) of the head and neck and account for fewer than 10% of all distant metastases [10,11]. In the head and neck area, the most frequent tumor which metastasizes to the skin is the atypical carcinoid.…”

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confidence: 99%

Incidence and Sites of Distant Metastases from Head and Neck Cancer

Ferlito

Shaha

Silver

et al. 2001

ORL

348

248

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The incidence of distant metastases in head and neck squamous cell carcinoma (SCC) is relatively small in comparison to other malignancies. Distant metastases adversely impact survival and may significantly affect treatment planning. The incidence of distant metastases is influenced by location of the primary tumor, initial T and N stage of the neoplasm, and the presence or absence of regional control above the clavicle. Patients with advanced nodal disease have a high incidence of distant metastases, particularly in the presence of jugular vein invasion or extensive soft tissue disease in the neck. Primary tumors of advanced T stages in the hypopharynx, oropharynx and oral cavity are associated with the highest incidence of distant metastases. Pulmonary metastases are the most frequent in SCC, accounting for 66% of distant metastases. It may be difficult to distinguish pulmonary metastasis from a new primary tumor, particularly if solitary. Other metastatic sites include bone (22%), liver (10%), skin, mediastinum and bone marrow. An important question remains as to how intensely pre- and postoperative screening for distant metastases should be performed. Preoperative chest X-ray is warranted in all cases. If the primary tumor and nodal status place the patient at high risk for pulmonary metastasis, then preoperative computed tomography scan of the chest should be done. Screening for distant metastases at other sites is usually not indicated in SCC of the upper aerodigestive tract. Postoperatively, annual X-rays of the chest are usually sufficient, but in high-risk situations a chest X-ray performed every 3–6 months may be beneficial. Certain histologic types of primary tumor have greater or lesser propensity to metastasize distantly, and have a different natural history. Adenoid cystic carcinoma metastasizes frequently, even in the absence of extensive local or regional disease. Basaloid squamous cell carcinoma and neuroendocrine carcinomas also metastasize widely. Extensive evaluation for distant metastases is justified for these tumors. Knowledge of the natural history of various neoplasms and the factors that contribute to distant metastases as well as good judgement are essential for cost-effective treatment planning and decision-making with regard to pre- and postoperative evaluation for distant metastases in cancer of the head and neck.

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Predicting factors for distant metastases in head and neck carcinomas: An analysis of 103 patients with locoregional control

Cited by 73 publications

References 30 publications

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Metastatic Oral Squamous Cell Carcinoma in a Montagu's Harrier (Circus Pigargus)

Incidence and Sites of Distant Metastases from Head and Neck Cancer

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