Pulmonary Metastasectomy for Head and Neck Squamous Cell Carcinoma in the Modern Treatment Era

Pulmonary metastasectomy (PM) has been a viable treatment option for metastatic head and neck squamous cell carcinoma (HNSCC). In recent years, advances in systemic therapy and multidisciplinary cancer management, including immune checkpoint inhibitors (ICIs), have changed the treatment landscape of advanced or recurrent head and neck cancer.

We retrospectively reviewed 44 patients who underwent complete resection for pulmonary metastases from HNSCC between 2008 and 2021. To minimize the risk of including primary lung cancer, 8 patients were excluded based on predefined clinical criteria, resulting in a final cohort of 36 patients for analysis. Patients were divided into the early (2008-2016) and late (2017-2021) period groups. Relapse-free survival (RFS), overall survival (OS), and prognostic factors were assessed.

The 5-year RFS and OS for all patients were 41% and 67%, respectively. Postoperative chemotherapy was associated with better RFS, and age ≤65 years with better OS. ICIs were administered to 1 patient in the early period group and 7 in the late period group during the clinical course (P = .005). The 5-year RFS and OS were 42% vs 40% and 55% vs 87% in the early and late period groups, respectively. While RFS was comparable, OS tended to be better in the late period group, although the difference was not statistically significant.

PM is associated with favourable long-term outcomes in patients with HNSCC. Given its potential for long-term survival and diagnostic value, PM remains an important treatment option for HNSCC in the modern treatment era.