Failure at distant sites following multimodality treatment for advanced head and neck cancer

Failure at distant sites has generally not been regarded as a major cause of morbidity and mortality in head and neck cancer. Among patients with advanced cancer of the mouth and throat, treated at Memorial Sloan-Kettering Cancer Center between 1960 and 1965, over 75% succumbed because of failure to control the disease, but distant metastases were the primary cause of failure in only 4%. More recently, with better local-regional control of cancer using multimodality treatment, failure at distant sites has become much more of a problem, however. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx with a combination of surgery and postoperative radiation therapy. Twenty-seven patients also received preoperative chemotherapy. Twenty patients developed distant metastases (12 in the lungs, 7 in the spine, and 1 on the trunk). The incidence of distant metastases was higher in those patients who presented with palpable cervical lymph nodes than in those who did not (25% vs. 4%, P less than 0.05), and especially in those patients who pathologically had metastases at multiple levels in the neck than in those who had metastases at a single level or had negative nodes (35% vs. 5%, P less than 0.05). Therapeutic strategies aimed at decreasing the incidence of distant metastases in patients with advanced head and neck cancer should be studied in patients who are pathologically found to have lymph node metastases at multiple levels in the neck.