Stereotactic radiotherapy in the management of oligometastatic and recurrent head and neck cancer: a single-center experience,Strahlentherapie und Onkologie

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Stereotactic radiotherapy in the management of oligometastatic and recurrent head and neck cancer: a single-center experience
Strahlentherapie und Onkologie ( IF 2.7 ) Pub Date : 2023-12-08 , DOI: 10.1007/s00066-023-02180-9
Ahmed Allam Mohamed _{1,

2} , Miguel Goncalves _{2,

3} , Biney Pal Singh _{1,

2} , Mareike Tometten _{2,

4} , Ashkan Rashad _{2,

5} , Frank Hölzle _{2,

5} , Stephan Hackenberg _{2,

3} , Michael Eble _{1,

2}

Affiliation

Introduction

Oligometastatic disease (OMD) is a metastatic stage that could benefit maximally from local therapies. Patients in this state have a better prognosis relative to those with disseminated metastases. Stereotactic radiotherapy provides a non-invasive ablative tool for primary malignant tumors and metastases.

Materials and methods

We searched our register for patients with oligometastatic or recurrent head and neck cancer (OMD/R-HNC) who received stereotactic radiotherapy to manage their OMD/R. We evaluated the survival outcomes and prognostic factors that affected the survival of those patients.

Results

In all, 31 patients with 48 lesions met the inclusion criteria for the analysis. The lesions comprised various metastatic sites, with the majority being pulmonary (37 lesions). Squamous cell cancer was the most common histology (26 patients). The median overall survival (mOS) was 33 months, with a progression-free survival (PFS) of 9.6 months. Eight patients received subsequent stereotactic radiotherapy after disease progression. The local control (LC) rates were 91.3, 87.7, and 83% at 6, 12, and 36 months. Patients with the de novo OMD who received stereotactic radiotherapy as their initial treatment had a median systemic treatment-free survival of 23.9 months. In univariate analysis, a trend for better OS was observed in patients with p16-positive squamous cell tumors; patients who progressed within 150 days after diagnosis had a significantly lower OS. De novo OMD showed significantly better PFS compared to induced OMD. Multivariate analyses identified p16-positive squamous cell cancer, metachronous OMD and a longer time to progression as positive predictors of OS, while de novo OMD was the only positive predictor for PFS. Treatment-related toxicities were generally mild, with two cases of grade 3 dysphagia reported.

Conclusion

Stereotactic radiotherapy demonstrated favorable outcomes in patients with OMD/R-HNC with limited toxicities. Further studies are warranted to validate these findings and optimize treatment strategies for this patient population.

中文翻译：

立体定向放射治疗治疗寡转移和复发性头颈癌：单中心经验

介绍

少转移性疾病 (OMD) 是可以从局部治疗中获得最大益处的转移阶段。与播散性转移的患者相比，处于这种状态的患者预后更好。立体定向放射治疗为原发性恶性肿瘤和转移瘤提供了一种非侵入性消融工具。

材料和方法

我们检索了登记册中接受立体定向放射治疗以控制 OMD/R 的寡转移或复发性头颈癌 (OMD/R-HNC) 患者。我们评估了影响这些患者生存的生存结果和预后因素。

结果

总共有 31 名患者（48 个病变）符合分析的纳入标准。病灶包括多个转移部位，其中大多数是肺部（37 个病灶）。鳞状细胞癌是最常见的组织学类型（26 名患者）。中位总生存期 (mOS) 为 33 个月，无进展生存期 (PFS) 为 9.6 个月。八名患者在疾病进展后接受了后续的立体定向放射治疗。 6、12 和 36 个月时的局部控制 (LC) 率分别为 91.3%、87.7% 和 83%。接受立体定向放射治疗作为初始治疗的新发 OMD 患者的中位全身无治疗生存期为 23.9 个月。在单变量分析中，观察到 p16 阳性鳞状细胞肿瘤患者的 OS 有更好的趋势；诊断后 150 天内病情进展的患者 OS 显着降低。与诱导 OMD 相比，从头 OMD 显示出明显更好的 PFS。多变量分析确定 p16 阳性鳞状细胞癌、异时 OMD 和较长的进展时间是 OS 的阳性预测因子，而从头 OMD 是 PFS 的唯一阳性预测因子。与治疗相关的毒性通常较轻微，有两例 3 级吞咽困难的病例报告。