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

Abstract

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.