Long-term outcome and patterns of failure in patients with advanced head and neck cancer

To access the long-time outcome and patterns of failure in patients with advanced head and neck squamous cell carcinoma (HNSCC).

Between 1992 and 2005 127 patients (median age 55 years, UICC stage III n=6, stage IV n=121) with primarily inoperable, advanced HNSCC were treated with definite platinum-based radiochemotherapy (median dose 66.4 Gy). Analysed end-points were overall survival (OS), disease-free survival (DFS), loco-regional progression-free survival (LPFS), development of distant metastases (DM), prognostic factors and causes of death.

The mean follow-up time was 34 months (range, 3-156 months), the 3-, 5- and 10-year OS rates were 39%, 28% and 14%, respectively. The median OS was 23 months. Forty-seven patients achieved a complete remission and 78 patients a partial remission. The median LPFS was 17 months, the 3-, 5- and 10-year LPFS rates were 41%, 33% and 30%, respectively. The LPFS was dependent on the nodal stage (p=0.029). The median DFS was 11 months (range, 2-156 months), the 3-, 5- and 10-year DFS rates were 30%, 24% and 22%, respectively. Prognostic factors in univariate analyses were alcohol abuse (n=102, p=0.015), complete remission (n=47, p<0.001), local recurrence (n=71, p<0.001), development of DM (n=45, p<0.001; median OS 16 months) and borderline significance in nodal stage N2 versus N3 (p=0.06). Median OS was 26 months with lung metastases (n=17). Nodal stage was a predictive factor for the development of DM (p=0.025). Cause of death was most commonly tumor progression.

In stage IV HNSCC long-term survival is rare and DM is a significant predictor for mortality. If patients developed DM, lung metastases had the most favourable prognosis, so intensified palliative treatment might be justified in DM limited to the lungs.