Leeman JE, et al. - This study was planned to determine patterns of treatment failure and postrecurrence outcomes among patients with head and neck squamous cell carcinoma (HNSCC) treated with modern definitive therapy. Researchers observed that in addition to surgical and systemic interventions, overall survival after recurrence of HNSCC was influenced by the HNSCC subsite and human papillomavirus or p16 status. An oligometastatic phenotype seemed associated with improved survival.

Methods

• Researchers performed this large single-institution cohort study.
• They reviewed the outcomes of 1000 consecutive patients with stage III to IVB oropharyngeal carcinoma (n = 703), laryngeal carcinoma (n = 126), or hypopharyngeal carcinoma (n = 46) treated with definitive intensity-modulated radiotherapy [IMRT] with or without concurrent chemotherapy, as well as patients with oral cavity carcinoma (n = 125) treated with postoperative IMRT with or without concurrent systemic therapy from December 1, 2001 to December 31, 2013;
• Median follow-up period was 65.1 months among surviving patients.
• They performed data analysis from January 31, 2016 to February 17, 2017.
• The outcomes assessed were patterns of treatment failure and overall survival following locoregional failure or distant metastasis.

Results

• Observations revealed no marginal or isolated out-of-radiation-field failures among the 1000 patients (186 women and 814 men; mean [SD] age, 59.3 [10.8] years).
• Among subsites, patients with oral cavity carcinoma vs those with oropharyngeal carcinoma indicated highest cumulative incidence of local failure (hazard ratio, 5.2; 95% CI, 3.1-8.6; P < .001).
• Following distant metastasis, significantly shorter survival was observed among patients with oral cavity carcinoma (hazard ratio, 3.66; 95% CI, 1.98-6.80; P < .001).
• After locoregional failure, patients with oropharyngeal carcinoma positive for human papillomavirus or p16 lived longer compared with patents with oropharyngeal carcinoma negative for human papillomavirus or p16 (median survival, 36.5 vs 13.6 months; P=.007) but this was not evident after distant metastasis.
• Following locoregional failure, salvage surgery was associated with improved overall survival (hazard ratio, 0.51; 95% CI, 0.34-0.77; P=.001).
• Improved overall survival was observed with oligometastatic disease (1 vs ≥2 lesions: hazard ratio, 0.32; 95% CI, 0.16-0.63; P=.001) following distant metastasis.