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Überleben mit hämatogen metastasierten HNO-Tumoren

Eine retrospektive monozentrische Analyse

Survival with distant metastatic disease in head and neck cancer

A retrospective analysis

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Zusammenfassung

Hintergrund

Ein monozentrisches Kollektiv von 114 Patienten mit hämatogen metastasierten HNO-Tumoren wurde mit der Fragestellung untersucht, welche Parameter das Überleben beeinflussten.

Patienten und Methoden

Primärer Endpunkt der retrospektiven Untersuchung war das Überleben mit Fernmetastasen, sekundärer das Gesamtüberleben. Als potenziell endpunktrelevante Einflussparameter wurden Primärtherapie, Lokalrezidiv, Zweittumor, palliative Chemotherapie (CHT) und Radiotherapie (RT) sowie der Karnofsky-Performance-Status (KPS) zum Zeitpunkt der Metastasendiagnose univariat (Log-rank-Test) bzw. multivariat (Cox-Regression) analysiert.

Ergebnisse

Palliative CHT (p=0,0020) und der KPS bei Erstdiagnose von Metastasen (p=0,0011) beeinflussten univariat signifikant positiv die mediane Überlebenswahrscheinlichkeit mit Metastasen (8,2 Monate), als unabhängiger prognostischer Parameter verblieb der KPS (p=0,0013). Primärtherapie (p=0,0139), lokale Tumorkontrolle (p=0,0106) und der KPS (p=0,0096) beeinflussten univariat signifikant positiv die mediane Gesamtüberlebenswahrscheinlichkeit (18,5 Monate), ebenso multivariat (p=0,0123 bzw. p=0,0063 bzw. p=0,0197).

Schlussfolgerung

Als prognostisch unabhängiger Parameter für das Überleben mit Metastasen und das Gesamtüberleben verblieb der KPS zum Zeitpunkt der Metastasendiagnose. Solange eine Lebensverlängerung nicht evident ist, sollten daher in der palliativen Therapie die Stabilisierung des KPS und der Lebensqualität im Vordergrund stehen.

Abstract

Questions

The objective of this retrospective analysis was to investigate parameters with a potential impact on survival in a collective of 114 patients with distant metastatic disease after head and neck cancer.

Patients and methods

The primary endpoint was the survival with distant metastatic disease, the secondary endpoint was overall survival. Primary therapy, local recurrence, second neoplasms, palliative chemotherapy (CHT) and radiotherapy (RT), as well as Karnofsky performance status (KPS) at the time of diagnosis of the metastases were analyzed as potential impact parameters using the log-rank test with subsequent Cox regression analysis.

Results

Palliative CHT (P=0.0020) and KPS (P=0.0011) had a significant positive impact on the median survival probability with metastases (8.2 months) using the log-rank test, KPS at the time of diagnosis of metastases remained as an independent prognostic parameter in the Cox regression (P=0.0013). Primary therapy, local tumor control and KPS had a significant positive influence on the median overall survival probability (18.5 months) univariately (P=0.0139, P=0.0106, P= 0.0096) and multivariately (P=0.0123, and P=0.0063, P=0.0197, respectively).

Conclusions

KPS at the time of diagnosis of metastases is an independent prognostic parameter for both endpoints. Lacking evidence for life prolongation, palliative therapies should therefore first and foremost focus on the stabilization of the KPS.

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Literatur

  1. Adamo V, Ferraro G, Pergolizzi S et al. (2004) Paclitaxel and cisplatin in patients with recurrent and metastatic head and neck squamous cell carcinoma. Oral Oncol 40: 525–531

    Article  PubMed  CAS  Google Scholar 

  2. Airoldi M, Cattel L, Marchionatti S et al. (2003) Docetaxel and vinorelbine in recurrent head and neck cancer: pharmacokinetic and clinical results. Am J Clin Oncol 26: 378–381

    Article  PubMed  CAS  Google Scholar 

  3. Arcangeli G, Giovinazzo G, Saracino B et al. (1998) Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration. Int J Radiat Oncol Biol Phys 42: 1119–1126

    Article  PubMed  CAS  Google Scholar 

  4. Ayache S, Peng J, Chatelain D et al. (2005) Therapeutic management of laryngeal cancer. Results of a study of 356 patients from the Cancer Registry of the Somme, France. Acta Otolaryngol 125: 1323–1326

    Article  PubMed  Google Scholar 

  5. Baumann I, Seibolt M, Zalaman I et al. (2006) Quality of life in patients with oropharyngeal carcinoma after primary surgery and postoperative irradiation. J Otolaryngol 35: 332–337

    Article  PubMed  Google Scholar 

  6. Baumann I, Seibolt M, Zalaman IM et al. (2006) Quality of life in patients with oropharyngeal carcinoma: Gender influences the subjective evaluation. HNO 54: 376–381

    Article  PubMed  CAS  Google Scholar 

  7. Bilde A, Von BC, Mortensen J et al. (2006) The role of SPECT-CT in the lymphoscintigraphic identification of sentinel nodes in patients with oral cancer. Acta Otolaryngol 126: 1096–1103

    Article  PubMed  Google Scholar 

  8. Buckley JG, Ferlito A, Shaha AR, Rinaldo A (2001) The treatment of distant metastases in head and neck cancer--present and future. ORL J Otorhinolaryngol Relat Spec 63: 259–264

    PubMed  CAS  Google Scholar 

  9. Budach W, Hehr T, Budach V et al. (2006) A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer 6: 28

    Article  PubMed  CAS  Google Scholar 

  10. Calhoun KH, Fulmer P, Weiss R, Hokanson JA (1994) Distant metastases from head and neck squamous cell carcinomas. Laryngoscope 104: 1199–1205

    Article  PubMed  CAS  Google Scholar 

  11. Catimel G, Vermorken JB, Clavel M et al. (1994) A phase II study of Gemcitabine (LY 188011) in patients with advanced squamous cell carcinoma of the head and neck. EORTC Early Clinical Trials Group. Ann Oncol 5: 543–547

    PubMed  CAS  Google Scholar 

  12. de Mulder PH (1999) The chemotherapy of head and neck cancer. Acta Otorhinolaryngol Belg 53: 247–252

    Google Scholar 

  13. Fanucchi M, Khuri FR (2004) Chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck. Semin Oncol 31: 809–815

    Article  PubMed  CAS  Google Scholar 

  14. Ferlito A, Shaha AR, Silver CE et al. (2001) Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 63: 202–207

    PubMed  CAS  Google Scholar 

  15. Forastiere AA, Metch B, Schuller DE et al. (1992) Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol 10: 1245–1251

    PubMed  CAS  Google Scholar 

  16. Gebbia V, Testa A, Di GC et al. (1995) Vinorelbine plus cisplatin in recurrent or previously untreated unresectable squamous cell carcinoma of the head and neck. Am J Clin Oncol 18: 293–296

    Article  PubMed  CAS  Google Scholar 

  17. Genet D, Cupissol D, Calais G et al. (2004) Docetaxel plus 5-fluorouracil in locally recurrent and/or metastatic squamous cell carcinoma of the head and neck: a phase II multicenter study. Am J Clin Oncol 27: 472–476

    Article  PubMed  CAS  Google Scholar 

  18. Hao D, Ritter MA, Oliver T, Browman GP (2006) Platinum-based concurrent chemoradiotherapy for tumors of the head and neck and the esophagus. Semin Radiat Oncol 16: 10–19

    Article  PubMed  Google Scholar 

  19. Haughey BH, Gates GA, Arfken CL, Harvey J (1992) Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol. Ann Otol Rhinol Laryngol 101: 105–112

    PubMed  CAS  Google Scholar 

  20. Hennemann B (2006) Palliative chemotherapy of head and neck cancer: present status and future development. Laryngorhinootologie 85: 172–178

    Article  PubMed  CAS  Google Scholar 

  21. Herborn CU, Unkel C, Vogt FM et al. (2005) Whole-body MRI for staging patients with head and neck squamous cell carcinoma. Acta Otolaryngol 125: 1224–1229

    Article  PubMed  Google Scholar 

  22. Hoegler D (1997) Radiotherapy for palliation of symptoms in incurable cancer. Curr Probl Cancer 21: 129–183

    Article  PubMed  CAS  Google Scholar 

  23. Jackel MC, Reck R (2006) Transoral resection of locally advanced squamous cell carcinoma of the lateral oropharynx: combination of CO2 laser microsurgery with flap reconstruction. HNO 54: 605–610

    Article  PubMed  CAS  Google Scholar 

  24. Jacobs C, Lyman G, Velez-Garcia E et al. (1992) A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 10: 257–263

    PubMed  CAS  Google Scholar 

  25. Kirkbride P, Mackillop WJ, Priestman TJ et al. (1996) The role of palliative radiotherapy for bone metastases. Can J Oncol 6 [Suppl 1]: 33–38

  26. Konski A, Feigenberg S, Chow E (2005) Palliative radiation therapy. Semin Oncol 32: 156–164

    Article  PubMed  Google Scholar 

  27. Ledeboer QC, Van d V, De Boer MF et al. (2006) Palliative care for head and neck cancer patients in general practice. Acta Otolaryngol 126: 975–980

    Article  PubMed  Google Scholar 

  28. Leon X, Quer M, Diez S et al. (1999) Second neoplasm in patients with head and neck cancer. Head Neck 21: 204–210

    Article  PubMed  CAS  Google Scholar 

  29. Moosmann P, Egli F, Stahel RA, Jost L (2003) Weekly paclitaxel and carboplatin combination chemotherapy in patients with advanced squamous cell carcinoma of the head and neck. Onkologie 26: 568–572

    Article  PubMed  CAS  Google Scholar 

  30. Piccirillo JF (2000) Importance of comorbidity in head and neck cancer. Laryngoscope 110: 593–602

    Article  PubMed  CAS  Google Scholar 

  31. Pignon JP, Bourhis J, Domenge C, Designe L (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355: 949–955

    PubMed  CAS  Google Scholar 

  32. Pinto HA, Jacobs C (1991) Chemotherapy for recurrent and metastatic head and neck cancer. Hematol Oncol Clin North Am 5: 667–686

    PubMed  CAS  Google Scholar 

  33. Ricke J, Wust P, Wieners G et al. (2005) CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique. Chest 127: 2237–2242

    Article  PubMed  Google Scholar 

  34. Saxman S, Mann B, Canfield V et al. (1998) A phase II trial of vinorelbine in patients with recurrent or metastatic squamous cell carcinoma of the head and neck. Am J Clin Oncol 21: 398–400

    Article  PubMed  CAS  Google Scholar 

  35. Schrijvers D, Vermorken JB (2000) Role of taxoids in head and neck cancer. Oncologist 5: 199–208

    Article  PubMed  CAS  Google Scholar 

  36. Schwentner I, Obrist P, Thumfart W, Sprinzl G (2006) Distant metastasis of parotid gland tumors. Acta Otolaryngol 126: 340–345

    Article  PubMed  Google Scholar 

  37. Shah JP, Lydiatt W (1995) Treatment of cancer of the head and neck. CA Cancer J Clin 45: 352–368

    Article  PubMed  CAS  Google Scholar 

  38. Shaw HJ (1985) Palliation in head and neck cancer. J Laryngol Otol 99: 1131–1142

    PubMed  CAS  Google Scholar 

  39. Simon C, Plinkert PK (2006) Transoral resection of locally advanced squamous cell carcinoma of the side wall of the oropharynx: multimodal treatment concepts in transition. HNO 54: 589–590

    Article  PubMed  CAS  Google Scholar 

  40. Uppelschoten JM, Wanders SL, de Jong JM (1995) Single-dose radiotherapy (6 Gy): palliation in painful bone metastases. Radiother Oncol 36: 198–202

    Article  PubMed  CAS  Google Scholar 

  41. Werner JA (2005) Sentinel lymphadenectomy as a staging procedure. HNO 53: 511–512

    Article  PubMed  CAS  Google Scholar 

  42. Wulf J, Haedinger U, Oppitz U et al. (2004) Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: a noninvasive treatment approach in medically inoperable patients. Int J Radiat Oncol Biol Phys 60: 186–196

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Strahlentherapie, Universität Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Deutschland

    B. Dietl, C. Schaefer, F. Pohl & O. Kölbl

  2. Abteilung für Nuklearmedizin, Universität Regensburg, Regensburg, Deutschland

    J. Marienhagen

  3. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Regensburg, Deutschland

    T. Murthum

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  1. B. Dietl
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  2. J. Marienhagen
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  3. C. Schaefer
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  4. F. Pohl
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  6. O. Kölbl
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Correspondence to B. Dietl.

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Dietl, B., Marienhagen, J., Schaefer, C. et al. Überleben mit hämatogen metastasierten HNO-Tumoren. HNO 55, 785–791 (2007). https://doi.org/10.1007/s00106-006-1522-4

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