Locoregional treatment of primary tumor in synchronous metastatic head and neck squamous cell carcinomas

Figures & data

Table 1. Initial patients characteristics.

		Included patients (n = 148)		Systemic treatment alone (n = 80)		Locoregional + systemic treatment (n = 68)
Characteristics		N	%	N	%	N	%	p-value
Performance Status	Good	135	91.22	69	46.62	66	44.59	.020
	Poor	13	8.78	11	7.43	2	1.35
Sex	Male	132	89.19	72	48.65	60	40.54	.730
	Female	16	10.81	8	5.41	8	5.41
Age at diagnostic (years old)	<65	102	68.92	52	35.14	50	33.78	.260
	≥65	46	31.08	28	18.92	18	12.16
Smoking habits	No	9	6.08	3	2.03	6	4.05	.198
	Yes	139	93.92	77	52.03	62	41.89
Alcohol consumption	No	30	20.27	16	10.81	14	9.46	.804
	Yes	113	76.35	62	41.89	51	34.46
	.	5	3.38	2	1.35	3	2.03
Malnutrition	Yes	128	86.49	68	45.95	60	40.54	.767
	No	16	10.81	10	6.76	6	4.05
	.	4	2.70	2	1.35	2	1.35
Primary tumor	Oral cavity	13	8.78	8	5.41	5	3.38	.862
	Oropharynx	61	41.22	32	21.62	29	19.59
	Hypopharynx	54	36.49	28	18.92	26	17.57
	Larynx	20	13.51	12	8.11	8	5.41
Stade T	1	8	5.41	4	2.70	4	2.70	.484
	2	18	12.16	7	4.73	11	7.43
	3	39	26.35	24	16.22	15	10.14
	4	82	55.41	44	29.73	38	25.68
	.	1	0.68	1	0.68	.	.
Stade N	0	11	7.43	6	4.05	5	3.38	.290
	1	5	3.38	1	0.68	4	2.70
	2	2	1.35	1	0.68	1	0.68
	2a	3	2.03	3	2.03	.	.
	2b	37	25.00	17	11.49	20	13.51
	2c	41	27.7	26	17.57	15	10.14
	3	49	33.11	26	17.57	23	15.54
Number of metastases	1	17	11.49	4	2.7	13	8.78	.012
	2–3	28	18.92	12	8.11	16	10.81
	>3	16	10.81	11	7.43	5	3.38
	.	87	58.78	53	35.81	34	22.97
Number of metastatic sites	1	120	81.08	64	43.24	56	37.84	.715
	≥2	28	18.92	16	10.81	12	8.11
Metastatic site	Lung	113	76.35	60	40.54	53	35.81	.160
	Bone	17	11.49	13	8.78	4	2.70
	Liver	13	8.78	5	3.38	8	5.41
	Other	5	3.38	2	1.35	3	2.03

Figure 1. Overall survival. (A) Overall survival for patients receiving locoregional plus systemic therapy versus systemic therapy. (B) Overall survival for patients receiving systemic therapy plus locoregional radiotherapy with a dose equal to 70 Gy versus a dose inferior to 70 Gy versus systemic therapy alone.

Figure 2. Progression free survival. (A) Progression free survival for patients receiving locoregional plus systemic therapy versus systemic therapy. (B) Progression free survival for patients receiving systemic therapy plus locoregional radiotherapy with a dose equal to 70 Gy versus a dose inferior to 70 Gy versus systemic therapy alone.

Table 2. Univariate and multivariate analysis for overall survival in entire cohort (n = 148).

			Univariate			Multivariate 1			Multivariate 2
Variable		N events	HR	95% CI	p-value	HR	95% CI	p-value	HR	95% CI	p-value
Age at diagnosis	<65 years old	90	1	–	–	–^a			–^b
	≥65 years old	36	1.03	0.70–1.53	.869
Malnutrition	No	14	1	–	–	–^a			–^b
	Yes	109	0.93	0.51–1.67	.802
Comorbidities	No	71	1	–	–	–^a			–^b
	Yes	55	1.19	0.83–1.71	.338
Smoking habits	No	4	1	–	–	1	–	–	1	–	–
	Yes	122	2.73	1.01–7.41	.049	1.72	0.62–4.80	0.297	1.87	0.66–5.29	.237
Smoking cessation	Yes	49	1	–	–	–^a			–^b
	No	42	1.22	0.80–1.85	.355
Performance Status	Good	116	1	–	–	1	–	–	1	–	–
	Poor	10	2.40	1.24–4.66	.009	2.24	1.06–4.73	0.034	2.43	1.13–5.23	.023
Grade	Grade 1-2	71	1	–	–	–^a			–^b
	Grade 3	55	0.99	0.69–1.41	.957
Primary tumor	Oropharynx	70	1	–	–	1	–	–	1	–	–
	Oral cavity or hypopharynx or larynx	56	1.35	0.95–1.94	.097	1.43	0.99–2.06	0.054	1.39	0.95–2.04	.088
Number of metastases	>3	9	1	–	.517	–^a			–^b
	1	120	0.74	0.43–1.26
	2–3	19	0.83	0.46–1.48
Metastatic site	Lungs	97	1	–	–	–^a			–^b
	Other	29	1.12	0.74–1.70	.606
N classification	N0-2	84	1	–	–	1	–	–	1	–	–
	N3	42	1.50	1.03–2.19	.033	1.72	1.16–2.54	0.007	1.63	1.08–2.47	.02
T classification	T1-2	23	1	–	–	–^a			–^b
	T3-4	102	1.29	0.82–2.03	.277
Chemotherapy protocol	Polychemotherapy	119	1	–	–	1	–	–	1	–	–
	Monochemotherapy	5	2.78	1.11–6.98	.030	1.85	0.65–5.24	0.248	1.77	0.61–5.09	.293
Type of treatment	Systemic + locoregional	58	1	–	–	1	–	–	–^b
	Systemic alone	68	1.85	1.29–2.63	<.001	1.94	1.33–2.82	<.001
Dose of radiotherapy delivered	=70 Gy	25	1	–	.001	–^a			1	–	<.001
	<70 Gy	24	1.99	1.13–3.52					2.10	1.17–3.78
	No locoregional treatment	68	2.40	1.51–3.83					2.53	1.56–4.10

^aDropped from the multivariate model 1.

^bDropped from the multivariate model 2.

Table 3. Univariate and multivariate analysis for overall survival in patients with partial, complete or stable metastatic response (n = 75).

			Univariate			Multivariate 1			Multivariate 2
Variable		N events	HR	95% CI	p-value	HR	95% CI	p-value	HR	95% CI	p-value
Age at diagnosis	<65 years old	45	1	–	–	–^a			–^b
	≥65 years old	18	1.21	0.69–2.11	.506
Malnutrition	No	5	1	–	–	–^a			–^b
	Yes	58	0.85	0.34–2.15	.732
Comorbidities	No	40	1	–	–	–^a			–^b
	Yes	23	1.29	0.76–2.18	.339
Smoking habits	No	3	1	–	–	1	–	–	1	–	–
	Yes	60	2.79	0.87–8.92	.084	1.84	0.54–6.19	0.327	2.26	0.63–8.12	.211
Smoking cessation	Yes	27	1	–	–	–^a			–^b
	No	20	1.06	0.59–1.9	.852
Performance Status	Good	62	1	–	–	–^a			–^b
	Poor	1	NA	NA	1
Grade	Grade 1–2	37	1	–	–	–^a			–^b
	Grade 3	26	1.31	0.79–2.18	.299
Primary tumor	Oropharynx	31	1	–	–	1	–	–	1	–	–
	Oral cavity or hypopharynx or larynx	32	2.25	1.31–3.87	.003	2.49	1.42–4.34	0.001	2.44	1.33–4.47	.004
Number of metastases	>3	9	1	–	.64	–^a			–^b
	1	120	0.87	0.42–1.81
	2–3	19	1.08	0.47–2.46
Metastatic site	Lungs	47	1	–	–	–^a			–^b
	Other	16	1.29	0.72–2.29	.390
N classification	N0-2	37	1	–	–	1	–	–	1	–	–
	N3	26	1.65	0.99–2.75	.054	1.6	0.93–2.73	0.087	1.35	0.73–2.49	.335
T classification	T1-2	16	1	–	–	–^a			–^b
	T3-4	47	1.05	0.59–1.89	.866
Chemotherapy protocol	Polychemotherapy	63	1	–	–	–^a			–^b
	Monochemotherapy	0	NA	NA	1
Type of treatment	Systemic + locoregional	40	1	–	–	1	–	–	–^b
	Systemic alone	23	1.69	1–2.86	.049	1.99	1.13–3.51	0.017
Dose of radiotherapy delivered	=70 Gy	19	1	–	.020	–^a			1	–	.013
	<70 Gy	23	2.26	1.20–4.25					2.47	1.27–4.80
	No locoregional treatment	13	2.37	1.14–4.92					2.40	1.11–5.16

^aDropped from the multivariate model 1.

^bDropped from the multivariate model 2.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.