The incidence of metastases after multimodal therapy for cancer of the head and neck

Abstract

Combined therapeutic regimens integrating chemotherapy, radiation therapy, and surgery are reported to be effective in treating advanced squamous cell carcinomas of the head and neck. The current study evaluates 58 consecutive patients with advanced (T4, N3) head and neck cancers. Forty patients (multimodal group) were treated with 2 courses of chemotherapy (cisplatin 2 mg/kg; methotrexate 280–560 mg/m2 with leucovorin rescue; bleomycin 30 μ ×3) followed by radiation therapy and surgery. Eighteen patients (combined group) were treated with preoperative radiation therapy followed by surgery. In the multimodal group there were 27 (67.5%) partial responses and nine (22.5%) complete responses, for an overall response rate of 90%. Response rates by site of primary lesion were: oral cavity, 11 of 11; oropharynx, 13 of 17; hypopharynx, 5 to 5; and larynx 7 of 7. Distant metastases (skin, lung, bone, central nervous system [CNS]) appeared in 16 patients (40%) (P < 0.05 versus combined) at a median time of 8.5 months after diagnosis, 15 in patients having a partial (11) or complete (4) response. Thirteen patients (33%) developed distant metastases within 1 year of diagnosis (P < 0.05 versus combined). In 11 of these patients, the primary lesion and neck disease were resectable. Two thoracotomies were performed for solitary pulmonary metastases; one was resected for cure. Fifteen patients (38%) underwent curative resection; 11 (73%) were alive at 1 year, and ten (67%) were free of disease. Overall survival was 20 of 40 (50%) at 1 year. In the combined group, there were 14 partial responses (78%) and no complete responses. Early distant metastases appeared in two patients (12.5%), at 2 and 6 months after diagnosis. Seven patients (38%) underwent curative resection; six of seven (86%) were alive at 1 year, four of seven (57%) were disease‐free. Six of 16 patients at risk (37.5%) survived 1 year. After combined therapy, six of ten patients (60%) with responses to therapy survived 1 year versus 12 of 20 responders (57%) without distant metastases in the multimodal group. It is concluded that multimodal therapy for advanced head and neck cancer results in a higher response rate than with conventional combined therapy. The incidence of early and postoperative distant metastases was increased after the multimodal regimen. At 1 year there were no differences in survival between the combined and multimodal groups for responders without early metastases. Further observation is needed to determine the net long‐term effects of this regimen. A prospective randomized comparison of combined and multimodal therapy for advanced lesions is indicated.

Single-cell sequencing: a promising approach for uncovering the mechanisms of tumor metastasis

“…Interaction between tumor drug resistance and metastasis has been shown in recent years. Long-term exposure to chemotherapeutic drugs greatly promotes tumor invasion and metastasis [ 96 , 97 ], and drug-resistant cells are more likely to metastasize [ 98 – 100 ]. SCS can be used to study and analyze drug-resistant tumor cells to avoid the interference of tumor heterogeneity, providing a new perspective for exploring tumor metastasis.…”

Can cancer chemotherapy enhance the malignant behaviour of tumours?

“…Thus metastases can appear in sites following treatment in which they are rarely, if ever, seen normally. For example, Slotman et al [135] found an increased incidence of hematogenous metastases with induction chemotherapy for advanced squamous cell carcinomas of the head and neck, when compared with patients receiving only surgery and radiotherapy. Additionally, they found an increase in the proportion of patients with metastases in sites other than the usual pulmonary site.…”

Die Wertigkeit der Computertomographie des Thorax im Rahmen des Stagings von fortgeschrittenen Kopf-Hals-Malignomen

“…fanden in einer retrospektiven Arbeit bei 18 von 214 Patienten pathologische CTT-Befunde, ohne dass sich hieraus eine Konsequenz auf das therapeutische Vorgehen ergab. Diese Autoren sehen daher derzeit die Indikation zur CTT nur vor ausgedehnten onkochirurgischen Eingriffen[20].Es liegen Hinweise darauf vor, dass sich das Auftreten von Fernmetastasen durch eine adjuvante Chemotherapie verringern ließe[21]. Es gibt aktuell aber noch keine Standardregime hinsichtlich der Medikamente oder der Dosierungen[22].…”