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. 2020 Aug;42(8):1939-1953.
doi: 10.1002/hed.26117. Epub 2020 Mar 4.

Outcomes and toxicities following stereotactic ablative radiotherapy for pulmonary metastases in patients with primary head and neck cancer

Dario Pasalic  1 , Sonia L Betancourt-Cuellar  2 , Nicolette Taku  1 , Ethan B Ludmir  1 , Yi Lu  3 , Pamela K Allen  1 , Chad Tang  1 , Mara B Antonoff  4 , Clifton D Fuller  1 , David I Rosenthal  1 , William H Morrison  1 , Jack Phan  1 , Adam S Garden  1 , James W Welsh  1 , Joe Y Chang  1 , Zhongxing Liao  1 , Jeremy J Erasmus  2 , Quynh-Nhu Nguyen  1
Affiliations

Outcomes and toxicities following stereotactic ablative radiotherapy for pulmonary metastases in patients with primary head and neck cancer

Dario Pasalic et al. Head Neck. 2020 Aug.

Abstract

Background: Metastatic head and neck cancers (HNCs) predominantly affect the lungs and have a two-year overall survival (OS) of 15% to 50%, if amenable for pulmonary metastasectomy.

Methods: Retrospective review of the two-year local control (LC), local-regional control (LRC) within the same lobe, OS, and toxicity rates in consecutive patients with metastatic pulmonary HNC who underwent stereotactic ablative radiotherapy (SABR) January 2007 to May 2018.

Results: Evaluated 82 patients with 107 lung lesions, most commonly squamous cell carcinoma (SCC; 64%). Median follow-up was 20 months (range: 9.0-97.6). Systemic therapy administered in 34%. LC, LRC, and OS rates were 94%, 90%, and 62%. Patients with oligometastatic disease had a higher OS than polymetastatic disease, 72% vs 44% (HR = 0.30, 95% CI: 0.14-0.64; P = .008). OS in oligometastatic non-SCC and SCC were 100% and 66% (P = .03). There were no grade ≥3 toxicities.

Conclusions: Metastatic pulmonary HNCs after SABR have a two-year OS rate comparable to pulmonary metastasectomy.

Keywords: oligometastasis; pulmonary metastases; pulmonary oligometastases; squamous cell carcinoma; stereotactic body radiotherapy.

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Figures

FIGURE A1
FIGURE A1
Kaplan-Meier OS curves for the study patients with oligometastatic disease grouped according to non-squamous cell vs squamous cell histology
FIGURE A2
FIGURE A2
Kaplan-Meier OS curves for all patients grouped according to metachronous vs synchronous disease
FIGURE A3
FIGURE A3
Kaplan-Meier OS curves for the patients with squamous cell lung lesions grouped according to metachronous vs synchronous disease
FIGURE 1
FIGURE 1
Kaplan-Meier overall survival curves for the study patients grouped according to oligometastatic disease (up to three lung lesions and consolidation of all lung lesions with stereotactic radiation) vs polymetastatic disease (more than three lung lesions and/or partial consolidation of lung lesions). The overall survival rate was significantly higher (hazard ratio [HR] = 0.30, 95% confidence interval [CI]: 0.14-0.64; Log-Rank P = .008) in the oligometastatic group (dashed line) than in the polymetastatic group (solid line) at 12 months (78.6% vs 67.9%), 24 months (71.6% vs 43.8%), and 36 months (63.7% vs 34.0%)
FIGURE 2
FIGURE 2
Kaplan-Meier overall survival curves for the study patients grouped according to squamous cell histology vs non-squamous cell histology (consisting of papillary thyroid, adenoid cystic, sarcoma, adenocarcinoma, follicular thyroid, salivary duct, and neuroendocrine cell origins). The overall survival rate was significantly lower (hazard ratio [HR] = 2.33, 95% confidence interval [CI]: 1.12-4.81; log-rank P = .045) in the squamous cell group (dashed line) than in the nonsquamous cell group (solid line) at 12 months (67.0% vs 92.2%), 24 months (54.7% vs 77.4%), and 36 months (48.2% vs 63.3%)
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