Persistent Head and Neck Cancer Following First-Line Treatment

• Main Authors: Teresa Bernadette Steinbichler, Madeleine Lichtenecker, Maria Anegg, Daniel Dejaco, Barbara Kofler, Volker Hans Schartinger, Maria-Therese Kasseroler, Britta Forthuber, Andrea Posch, Herbert Riechelmann
• Format: Article
• Language: English
• Published: MDPI AG 2018-11-01
• Series: Cancers
• Subjects: persistent disease; salvage surgery; SBRT (stereotactic body radiotherapy); second-line treatment; neck dissection; complete response; best supportive care
• Online Access: https://www.mdpi.com/2072-6694/10/11/421

<i>Background:</i> Following first-line treatment of head and neck cancer (HNC), persistent disease may require second-line treatment. <i>Methods:</i> All patients with HNC treated between 2008 and 2016 were included. Second-line treatment modalities and survival of patients were analyzed. <i>Results:</i> After first-line therapy, 175/741 patients had persistent disease. Of these, 112 were considered eligible for second-line treatment. Second-line treatment resulted in 50% complete response. Median overall survival of patients receiving second-line therapy was 24 (95% CI: 19 to 29) months; otherwise survival was 10 (9 to 11; <i>p</i> &lt; 0.0001) months. Patients receiving second-line surgery had a median overall survival of 45 (28 to 62) months, patients receiving second-line radiotherapy had a median overall survival of 37 (0 to 79; <i>p</i> = 0.17) months, and patients receiving systemic therapy had a median overall survival of 13 (10 to 16; <i>p</i> &lt; 0.001) months. Patients with persistent HNC in the neck had a better median survival (45 months; 16 to 74 months; <i>p</i> = 0.001) than patients with persistence at other sites. <i>Conclusion:</i> Early treatment response evaluation allows early initiation of second-line treatment and offers selected patients with persistent disease a realistic chance to achieve complete response after all. If possible, surgery or radiotherapy are preferable.