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Detection of Distant Metastases in Head and Neck Cancer: Changing Landscape

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Abstract

As head and neck squamous cell carcinoma (HNSCC) patients with distant metastases (DM) were generally treated only palliatively, the value of screening for DM was usually limited to attempts to avoid extensive locoregional treatment when DM were present pretreatment. Recently, the concept of treating oligometastases, e.g., by metastatectomy or stereotactic body radiotherapy, has been reintroduced for HNSCC and may cause a change in the treatment paradigm. Although whole body 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) combined with computed tomography (CT; WB-FDG-PET/CT) is still the mainstay diagnostic technique, there is a growing body of evidence supporting implementation of whole body magnetic resonance imaging (WB-MRI) as an important diagnostic technique for screening for DM. Also, FDG-PET/MRI may become a valuable technique for the detection of DM in HNSCC patients. Because the yield of examinations for detection of DM is too low to warrant routine screening of all HNSCC patients, only patients with high risk factors should be selected for intense screening for DM. Clinical and histopathological risk factors are mainly related to the extent of lymph node metastases. Risk for development of DM may also be assessed by molecular characterization of the primary tumor using genomic and proteomic technologies and radiomics. More research is needed to develop a new protocol for screening for DM after introduction of the concept of treating oligometastases in HNSCC.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

Disclosures

Remco de Bree, Asaf Senft, Andrés Coca-Pelaz, Luiz Kowalski, Fernando Lopez, William Mendenhall, Miquel Quer, Alessandra Rinaldo, Ashok R. Shaha, Primož Strojan, Robert P. Takes, Carl E. Silver, C. René Leemans, and Alfio Ferlito have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted and reported studies and does contain studies with human participants performed by any of the authors.

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Authors and Affiliations

  1. Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Remco de Bree

  2. Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands

    Remco de Bree, Asaf Senft & C. René Leemans

  3. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain

    Andrés Coca-Pelaz & Fernando Lopez

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil

    Luiz Kowalski

  5. Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain

    Fernando Lopez

  6. Department of Radiation Oncology, University of Florida, Gainesville, FL, USA

    William Mendenhall

  7. Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain

    Miquel Quer

  8. University of Udine School of Medicine, Udine, Italy

    Alessandra Rinaldo

  9. Head and Neck Service, Memorial Sloan–Kettering Cancer Center, New York, NY, USA

    Ashok R. Shaha

  10. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia

    Primož Strojan

  11. Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands

    Robert P. Takes

  12. Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA

    Carl E. Silver

  13. Coordinator of the International Head and Neck Scientific Group, Padua, Italy

    Alfio Ferlito

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  1. Remco de Bree
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  2. Asaf Senft
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Correspondence to Remco de Bree.

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de Bree, R., Senft, A., Coca-Pelaz, A. et al. Detection of Distant Metastases in Head and Neck Cancer: Changing Landscape. Adv Ther 35, 161–172 (2018). https://doi.org/10.1007/s12325-018-0662-8

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