A recent study uncovered the benefits of adding high-intensity local treatment to systemic therapy for head and neck squamous cell carcinoma, published in Cancer (online August 17, 2017; doi:10.1002/cncr.30933).
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Recent research has increasingly indicated that primary tumor ablation helps improve survival outcomes for some patients with cancer metastases, especially in head and neck squamous cell carcinoma due to its susceptibility to locoregional progression.
Zachary S Zumsteg, MD, department of radiation oncology, Cedars-Sinai Medical Center (Los Angeles, CA), and colleagues conducted a study to examine the effects of various treatment efforts for metastatic head and neck squamous cell carcinoma. A total of 3269 patients were sampled from the National Cancer Data Base who underwent systemic therapy. Researchers categorized those patients who underwent high-intensity local treatment, defined as a radiation dose of at least 60 Gy or oncologic resection of the primary tumor.
Researchers performed multivariate Cox regression, propensity score matching, landmark analysis, and subgroup analysis to account for covariates, including adjustments for the number and location of metastatic sits in various subsets of patients with available information.
After a median follow-up of 51.5 months, patients undergoing systemic therapy with local treatment had higher rates of survival than those receiving systemic therapy alone in propensity score-matched cohorts (2-year overall survival, 34.2% vs 20.6%, respectively; P < .001). Improved survival rates were only observed in patients receiving high-intensity local treatment, while those receiving lower-intensity local treatment had comparable survival rates to those receiving systemic therapy without local treatment.
Impact of high-intensity local therapy was time-dependent, researchers reported, with a stronger impact within the first 6 months after initial diagnosis (HR, 0.255; 95% CI, 0.210-0.309; P <.001) in comparison with more than 6 months after initial diagnosis (HR, 0.622; 95% CI, 0.561-0.689; P < .001) in the multivariate analysis.
Researchers noted that there was observable benefit in all subgroups; in landmark analyses of 1-year, 2-year, and 3-year survivors; and after adjusting for the number and location of metastatic sites.
“Aggressive local treatment warrants prospective evaluation for select patients with metastatic HNSCC,” authors of the study concluded.—Zachary Bessette
