Zumsteg ZS, et al. – Aim was to appraise the combined high–intensity local treatment and systemic therapy in metastatic head and neck squamous cell carcinoma (HNSCC). Based on the data obtained, this study proposed to prospectively evaluate aggressive local treatment for select patients with metastatic HNSCC.

Methods

• Patients with metastatic HNSCC undergoing systemic therapy identified in the National Cancer Data Base, were part of this study.
• Experts defined high-intensity local treatment as radiation doses ≥ 60 Gy or oncologic resection of the primary tumor.
• They regulated multivariate Cox regression, propensity score matching, landmark analysis, and subgroup analysis to account for imbalances in covariates, including adjustments for the number and location of metastatic sites in the subset of patients with this information available.

Results

• This study incorporated 3269 patients (median follow-up, 51.5 months).
• As compared to patients receiving systemic therapy alone in propensity score–matched cohorts (2-year overall survival, 34.2% vs 20.6%; P < .001), patients undergoing systemic therapy with local treatment had improved survival.
• Moreover, improved survival was associated only with patients receiving high-intensity local treatment.
• On the other hand, those receiving lower-intensity local treatment had survival similar to that of patients receiving systemic therapy without local treatment.
• In the multivariate analysis, the impact of high-intensity local therapy was time-dependent, with a stronger impact within the first 6 months after the diagnosis (adjusted hazard ratio [AHR], 0.255; 95% confidence interval [CI], 0.210-0.309; P < .001) in comparison with more than 6 months after the diagnosis (AHR, 0.622; 95% CI, 0.561-0.689; P < .001).
• Findings highlighted a benefit in all subgroups, in landmark analyses of 1-, 2-, and 3-year survivors, and when adjusting for the number and location of metastatic sites.