Locoregional failure and the risk of distant metastasis after modern radiotherapy for head and neck cancer

Abstract

Background: Evolving epidemiology and improvements in locoregional therapy necessitate reassessment of the relationship between locoregional failure and distant metastasis in squamous cell carcinoma of the head and neck (SCCHN).

Methods: Retrospective assessments of factors associated with distant metastasis-free survival were made for 560 patients with SCCHN who received definitive radiotherapy (RT) +/- concurrent systemic therapy at our institution between 1995 and 2007.

Results: Fifty-six patients (10.0%) developed distant metastasis. Three-year actuarial locoregional control and distant metastasis-free survival were 72% and 87%, respectively. Multivariate analysis revealed N classification and locoregional failure as significant predictors of reduced distant metastasis-free survival (p < .001). In patients with distant metastasis detected after locoregional failure, the mean interval between these events was 11.6 months.

Conclusion: Locoregional failure may play a causative role for distant metastasis in some patients with SCCHN, suggesting a need for continued focus on improving locoregional therapies.