Brain metastases from Head and Neck Cancer [Neurosurgery Wiki]

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====== Brain metastases from Head and Neck Cancer ======

Limited [[data]] is available on [[head and neck cancer]] (HNC) [[patient]]s presenting with [[brain metastases]] (BM) at [[initial diagnosis]]. 

Survival was significantly influenced by Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extracranial metastatic disease. These characteristics were included in a score.

Scoring was based on 6-month survival data: ECOG 0-1=1 point, ECOG 2-3=0 points, 1-3 cerebral lesions=1 point, ≥4 cerebral lesions=0 points, lack of extracranial metastases=1 point, and presence of extracranial metastases=0 points. Addition of these points for each patient resulted in 0-3 points. Three groups were built comprising 0-1, 2 and 3 points. Six-month survival rates for these groups were 0%, 50% and 100%, respectively.

This instrument guides physicians in choosing optimal irradiation programs for patients with cerebral metastases from head-and-neck cancer
((Rades D, Dziggel L, Hakim SG, Rudat V, Janssen S, Trang NT, Khoa MT, Bartscht T. Predicting Survival After Irradiation for Brain Metastases from Head and Neck Cancer. In Vivo. 2015 Sep-Oct;29(5):525-8. PMID: 26359409.)),
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Messing et al. sought to evaluate the [[incidence]], [[management]], and [[treatment outcome]]s of these patients using the [[National Cancer Database]] (NCDB).

They identified 465,925 patients diagnosed with HNC between 2010 and 2015 in the NCDB. 14,583 of these patients presented with [[metastatic disease]] to any site. 440 of these patients had BM at the time of initial diagnosis. [[Overall survival]] was compared using the [[Kaplan-Meier estimator]]. [[Cox]] [[Proportional hazards model]], [[propensity score matching]], and subgroup analyses were performed.

The [[median age]] overall was 62.0 years. [[Nasopharynx]] NOS (13.2%) and [[Parotid Gland]] (10.9%) were the most common anatomical sites with the highest frequency of BM. The [[overall median survival]] time was 7.1 months. [[Predictor]]s for the presence of BM included distant metastases to the bone, liver, or lung on [[univariate analysis]], and bone or lung on [[multivariate analysis]]. High-risk [[Human Papilloma Virus status]] was associated with a lower chance of BM. No pattern was determined when comparing [[lymph node]] level involvement and BM. The [[median survival]] for patients receiving [[radiation therapy]] and multi-agent [[chemotherapy]] was 8.4 and 11.7 months, respectively. [[Immunotherapy]] administered as first course therapy did not influence median survival. Most patients received radiation (62.7%) therapy and chemotherapy (50.2%).

The data extracted and analyzed from the NCDB should work to aid in the [[surveillance]] and management of BM in patients with HNC
((Messing I, Goyal S, Sherman JH, Thakkar P, Siegel R, Joshi A, Goodman J, Ojong-Ntui M, Rao YJ. Incidence and Prognosis of Brain Metastases in Head and Neck Cancer Patients at Diagnosis. Laryngoscope. 2021 Feb 18. doi: 10.1002/lary.29448. Epub ahead of print. PMID: 33599979.)).
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Out of 9432 HNC patients, 88 patients developed BM (0.9%, median follow-up 3.4 years). On average, the BM were diagnosed 18.5 months after the primary diagnosis and tended to arise after distant metastases to extracranial sites (85%) such as the lungs (78%). At BM presentation, 84% were symptomatic and two thirds had a poor performance status (ECOG ≥ 2, 68%). The median post-BM survival was 2.5 months (95% CI 2.1-3.3 months). On multivariable analysis, management of BM with radiotherapy (RT) alone (3.3 months, 95% CI 2.3-4.6, p = 0.005) and RT with surgery (4.4 months, 95% CI 2.8-6.9, p < 0.001) was associated with longer survival compared to best supportive care alone (1.4 months, 95% CI 1.0-2.0 months). Age, sex, performance status, sub-localization of the primary HNC, presence of extracranial metastases, and number of intracranial metastases were not associated with post-BM survival (all p ≥ 0.05).

BM occur late in the course of HNC and carry a poor prognosis. Treatment with intracranial radiotherapy both with and without surgery was associated with improved survival
((Liu AK, Wu J, Berthelet E, Lalani N, Chau N, Tran E, Hamilton SN. Clinical features of head and neck cancer patients with brain metastases: A retrospective study of 88 cases. Oral Oncol. 2021 Jan;112:105086. doi: 10.1016/j.oraloncology.2020.105086. Epub 2020 Nov 10. PMID: 33186892.)).

===== Brain metastases from Head and Neck squamous cell carcinoma =====

see [[Brain metastases from Head and Neck squamous cell carcinoma]].

===== References =====