Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_36_2849 - Suboptimal Outcomes in Patients with Cutaneous Squamous Cell Cancer of the Head and Neck with Nodal Metastases Treated with Surgery and Radiation Therapy

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Suboptimal Outcomes in Patients with Cutaneous Squamous Cell Cancer of the Head and Neck with Nodal Metastases Treated with Surgery and Radiation Therapy
V. Varra1, S. Koyfman2, C. A. Reddy2, N. P. Joshi2, J. L. Geiger3, D. J. Adelstein3, B. B. Burkey4, J. Scharpf4, B. Prendes4, E. Lamarre4, R. R. Lorenz4, B. Gastman5, B. Manyam2, and N. M. Woody2; 1Case Western Reserve University School of Medicine, Cleveland, OH, 2Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 3Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 4Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, 5Cleveland Clinic, Cleveland, OH

Purpose/Objective(s): We review outcomes of patients with nodal metastases from cutaneous squamous cell cancer of the head and neck (cSCC-HN) treated with surgery and radiotherapy (RT) to characterize survival, failure patterns and factors associated with disease recurrence.

Materials/Methods: Patients with a history of cSCC-HN who presented with metastases to the parotid and/or cervical lymph nodes in the absence of a mucosal primary tumor were included in this IRB approved study. All patients underwent parotidectomy, neck dissection and adjuvant ipsilateral RT (median dose 60Gy), with or without concurrent systemic therapy. Patients with distant metastases, satellitosis at the primary site or who were treated with palliative intent were excluded. Immunosuppressed patients included patients on chronic immunosuppressive medication (e.g. transplants, rheumatic disease) and those with chronic leukemias. Kaplan Meier analysis was used to calculate disease free (DFS) and overall survival (OS). Cumulative incidence curves were generated for disease recurrence (DR) which included locoregional (LRF) and distant failure (DF). Univariate (UVA) and multivariate analyses (MVA) for disease recurrence were performed using Cox proportional-hazards regression.

Results: Of the 75 patients included in this study (57 immunocompetent; 18 immunosuppressed), median age was 72 (31-94), and median follow up was 18 months. 70% of patients were staged as a primary T0/X, while 1%, 17% and 12% were T1, T2 and T4 respectively. The most common nodal stage was N2b (59%) followed by N1/2a (38%) and N3 (3%). 34 patients (45%) had poorly differentiated tumors, 32 (42%) had perineural invasion, 22 (29%) had lymphovascular invasion. Extracapsular extension (ECE) was present in 62 patients (82%) and was similar in the immunocompetent and immunosuppressed cohorts. 11 patients (14.5%) received cisplatin or cetuximab concurrently with RT. LRF occurred in 18 pts (24%) and DF in 14 (18%). 2yr OS, DFS and DR were 60%, 49% and 40% respectively. Immunosuppressed patients had significantly lower 2yr DFS (28% vs 55%; p=0.003) and higher disease recurrence rates (61% vs 34%; p=0.04) compared to immunocompetent patients. On MVA, immunosuppression (HR 2.2; p=0.05) and the use of chemotherapy (HR 2.7; p=0.02) were the only significant predictors of DR. In a separate analysis of only immunocompetent patients, the presence of ECE was the only factor associated with DR (p<0.0001). No immunocompetent patient failed in the absence of ECE.

Conclusion: Patients with nodal metastases from cutaneous SCC of the head and neck have suboptimal outcomes despite surgery and RT. The presence of ECE and immunosuppression are major drivers of disease recurrence. Treatment intensification in these cohorts, perhaps with immunotherapy, merits investigation.

Author Disclosure: V. Varra: None. S. Koyfman: Research Grant; Merck. C.A. Reddy: None. J.L. Geiger: None. D.J. Adelstein: None. B. Gastman: Speaker arrangement; Merck. B. Manyam: None.

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