Palliative radiotherapy for primary lesions of head and neck cancer with uncontrolled distant metastases

Kagawa Kazufumi

doi:10.5981/jjhnc.40.473

Among 463 patients who underwent radiotherapy for primary lesions of head and neck cancer between 2006 and 2013, 10 had uncontrolled distant metastases. There were 9 males and 1 female with a median age of 63 years. The primary lesion was the pharynx in 6, nasal cavity in 2, oral cavity in 1, and salivary gland in 1 patient. Histology was squamous cell carcinoma in 5, adenoid cystic carcinoma in 3, malignant melanoma in 1, and adenocarcinoma in 1 patient. The metastatic lesion was bone in 5 (including 1 with both bone and liver), and lung in 5 (including 2 with both lung and liver) patients. All metastases were multiple. Palliative radiotherapy was administered for primary lesions in a median dose of 60 Gy, and also for bone metastases in 3 patients. The grade of performance status (PS) was PS1 in 7, PS2 in 1, and PS3 in 2 patients before radiotherapy. The best tumor response within 90 days was CR in 4 and PR in 6 patients. Two adenoid cystic carcinoma patients developed marginal recurrences, resulting in a 1-year local control rate of 60%. The 1-year overall survival rate was 64% for patients with initial PS 1–2, and 0% with initial PS 3. The cause of death was meningitis carcinomatosa in 1, pleuritis carcinomatosa in 3, and aspiration pneumonitis in 1 patient. Patients with distant metastases could undergo palliative radiotherapy for their primary lesions if their initial PS was 2 or less, and life expectancy was prolonged by chemotherapy or targeted therapies.

Palliative radiotherapy for primary lesions of head and neck cancer with uncontrolled distant metastases

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