Long-term survival in patients with metastatic head and neck squamous cell carcinoma treated with metastasis-directed therapy

BACKGROUND: Our objective was to evaluate the outcomes of metastatic head and neck squamous cell carcinoma (HNSCC) by disease burden with an emphasis on metastasis-directed therapy (MDT) in patients with limited metastatic disease burden. METHODS: In total, 186 patients who developed metastatic disease after definitive therapy for HNSCC were included. Clinically and radiographically apparent metastases were enumerated. Kaplan-Meier methods were used to estimate survival. Cox regression was used to assess the association between clinical variables. RESULTS: Patients with a single metastasis had a 5-year overall survival (OS) of 35% (95% CI 16-54%) in contrast to patients with multiple metastases with a 5-year OS of 4% (95% CI 2-9%). Thirty patients (16.1%) underwent MDT. On multivariable analysis, oral cavity or sinonasal primary (HR 2.22 95% CI 1.16-4.25, p = 0.015; HR 4.88, 95% CI 1.10-21.70, p = 0.037, respectively) were associated with higher risk of death, whereas receipt of MDT (HR 0.36, 95% CI 0.17-0.74, p = 0.006) was associated with lower hazard of death. Median subsequent metastasis-free survival and 5-year survival after MDT (n = 30) were estimated at 26.4 months (95% CI: 9.8-54.0) and 31%, (95% CI: 15-48%). CONCLUSIONS: HNSCC patients with limited metastatic disease may derive significant benefit from MDT. Prospective trials evaluating MDT in HNSCC are warranted.