Research

Head & Neck Oncology

, 4:36

Open Access This content is freely available online to anyone, anywhere at any time.

Spinal metastasis in head and neck cancer

  • Gregory M TrillingAffiliated withBarts and The London School of Medicine and Dentistry, Queen Mary, University of London
  • , Hyongyu ChoAffiliated withBarts and The London School of Medicine and Dentistry, Queen Mary, University of London
  • , Mohamed A UgasAffiliated withBarts and The London School of Medicine and Dentistry, Queen Mary, University of London
  • , Samerah SaeedAffiliated withBarts and The London School of Medicine and Dentistry, Queen Mary, University of London
  • , Asia KatundaAffiliated withBarts and The London School of Medicine and Dentistry, Queen Mary, University of London
  • , Waseem JerjesAffiliated withDepartment of Surgery, Al-Yarmouk University CollegeDepartment of Surgery, UCL Medical SchoolLeeds Institute of Molecular Medicine, University of LeedsAcademic Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals NHS Trust
  • , Peter GiannoudisAffiliated withLeeds Institute of Molecular Medicine, University of LeedsAcademic Department of Trauma and Orthopaedic Surgery, Leeds Teaching Hospitals NHS Trust Email author 

Abstract

Background

The incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia. Notwithstanding advances in surgery and radiotherapy over the past several decades, the 5-year survival rate for head and neck cancer has stagnated and remains at 50–55%. This is due, in large part, to both regional and distant disease spread, including spinal metastasis. Spinal metastasis from head and neck cancer is rare, has a poor prognosis and can significantly impede end-stage quality of life; normally only palliative care is given.

This study aims to conduct a systematic review of the evidence available on management of spinal metastasis from head and neck cancer and to use such evidence to draw up guiding principles in the management of the distant spread.

Methods

Systematic review of the electronic literature was conducted regarding the management of spinal metastasis of head and neck malignancies.

Results

Due to the exceptional rarity of head and neck cancers metastasizing to the spine, there is a paucity of good randomized controlled trials into the management of spinal metastasis. This review produced only 12 case studies/reports and 2 small retrospective cohort studies that lacked appropriate controls.

Conclusion

Management should aim to improve end-stage quality of life and maintain neurological function. This review has found that radiotherapy +/− medical adjuvant is considered the principle treatment of spinal metastasis of head and neck cancers.

There is an absence of a definitive treatment protocol for head and neck cancer spinal metastasis. Our failure to find and cite high-quality scientific evidence only serves to stress the need for good quality research in this area.