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Cancer. 2017 Dec 1;123(23):4583-4593. doi: 10.1002/cncr.30933. Epub 2017 Aug 17.

Combined high-intensity local treatment and systemic therapy in metastatic head and neck squamous cell carcinoma: An analysis of the National Cancer Data Base.

Author information

1
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
2
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
3
Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, California.
4
Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
5
Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
6
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
7
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.

Abstract

BACKGROUND:

There is increasing evidence that primary tumor ablation can improve survival for some cancer patients with distant metastases. This may be particularly applicable to head and neck squamous cell carcinoma (HNSCC) because of its tropism for locoregional progression.

METHODS:

This study included patients with metastatic HNSCC undergoing systemic therapy identified in the National Cancer Data Base. High-intensity local treatment was defined as radiation doses ≥ 60 Gy or oncologic resection of the primary tumor. Multivariate Cox regression, propensity score matching, landmark analysis, and subgroup analysis were performed to account for imbalances in covariates, including adjustments for the number and location of metastatic sites in the subset of patients with this information available.

RESULTS:

In all, 3269 patients were included (median follow-up, 51.5 months). Patients undergoing systemic therapy with local treatment had improved survival in comparison with patients receiving systemic therapy alone in propensity score-matched cohorts (2-year overall survival, 34.2% vs 20.6%; P < .001). Improved survival was associated only with patients receiving high-intensity local treatment, whereas those receiving lower-intensity local treatment had survival similar to that of patients receiving systemic therapy without local treatment. The impact of high-intensity local therapy was time-dependent, with a stronger impact within the first 6 months after the diagnosis (adjusted hazard ratio [AHR], 0.255; 95% confidence interval [CI], 0.210-0.309; P < .001) in comparison with more than 6 months after the diagnosis (AHR, 0.622; 95% CI, 0.561-0.689; P < .001) in the multivariate analysis. A benefit was seen in all subgroups, in landmark analyses of 1-, 2-, and 3-year survivors, and when adjusting for the number and location of metastatic sites.

CONCLUSIONS:

Aggressive local treatment warrants prospective evaluation for select patients with metastatic HNSCC. Cancer 2017;123:4583-4593. © 2017 American Cancer Society.

KEYWORDS:

National Cancer Data Base; distant metastasis; head and neck cancer; local treatment; stage IVC

PMID:
28817183
PMCID:
PMC5745815
DOI:
10.1002/cncr.30933
[Indexed for MEDLINE]
Free PMC Article

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