PV-213 Pulmonary metastasectomy is superior to chemotherapy for patients with pulmonary metastatic head and neck cancer.

Objectives Pulmonary metastasectomy (PM) is an established procedure for patients with metastatic head and neck cancer (HNC). Chemo- and radiotherapy are also treatment options. There are no randomized controlled trials and almost no retrospective studies comparing PM with chemotherapy. In this study, however, we compared the survival of HNC patients with isolated pulmonary metastases who underwent PM with patients who received chemotherapy.

Methods Between 01/2014 and 01/2020 62 HNC patients with isolated pulmonary metastases were included into our analysis. 33 underwent PM as curative approach and 29 underwent chemotherapy. We excluded patients with any other distant metastases.

The primary HNC in all patients was resected radically in a curative attempt. All pulmonary lesions in the chemotherapy group were pathologically diagnosed in advance of therapy. Follow-up data was enrolled with an average of 36 months.

Results Histology, tumor stage, manifestation, or treatment of the primary HNC differed between the groups. Severe side effects after medical treatment were observed in 14% of patients (acute kidney injury, hematopoiesis disorder), whereas 6% of patients showed postoperative pneumonia after PM. One rethoracotomy was performed due to pneumothorax. Disease free interval (DFI) between primary tumor and the occurrence of pulmonary metastases differed significantly (PM 52.6±26.1 vs. chemotherapy 24.1±28.2; p=0.004). Furthermore, patients undergoing chemotherapy were diagnosed more frequently with bilateral metastases (18.2%vs.41.4%; p=0.04). Number of metastases patients age as well as ASA classification did not differ between groups. Overall Patients undergoing PM showed significantly better 1- (93.5%vs.64.3%; p=0.008), 3- (72.2%vs.30.4%; p=0.01) and 5-year (53.4%vs.20.0%; p=0.04) survival rates, with median survival of 65.5 months vs. 19.1 months; p<0.0001 compared to patients receiving chemotherapy.

Conclusions Patients with pulmonary metastatic HNC undergoing PM have a significantly better overall survival compared to patients receiving chemotherapy only. HNC patients with pulmonary metastases should always be discussed in a multi-disciplinary tumor conference in order to optimize the therapy and the outcome of every patient with pulmonary metastatic HNC.

Publication History

Article published online:
06 September 2021