Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review.

Background and Objectives: The incidence of distant metastases in patients with head and neck cancer (HNC) is approximately 10%. Pulmonary metastases are the most frequent distant location, with an incidence of 70-85%. The standard treatment options are chemo-, immuno- and radiotherapy. Despite a benefit for long-term survival for patients with isolated pulmonary metastases, pulmonary metastasectomy (PM) is not the treatment of choice. Furthermore, many otorhinolaryngologists are not sufficiently familiar with the concept of PM. This work reviews the recent studies of pulmonary metastatic HNC and the results after pulmonary metastasectomy. Materials and Methods: PubMed, Medline, Embase, and the Cochrane library were checked for the case series' of patients undergoing metastasectomy with pulmonary metastases published since 1 January 2000. Results: We included the data of 15 studies of patients undergoing PM. The 5-year survival rates varied from 21% to 59%, with median survival from 10 to 77 months after PM. We could not identify one specific prognostic factor for long-term survival after surgery. However, at least most studies stated that PM should be planned if a complete (R0) resection is possible. Conclusions: PM showed reliable results and is supposedly the treatment of choice for patients with isolated pulmonary metastases. Patients not suitable for surgery may benefit from other non-surgical therapy. Every HNC patient with pulmonary metastases should be discussed in the multidisciplinary tumor board to optimize the therapy and the outcome.

Pulmonary metastasectomy for metastatic head and neck cancer prolongs survival significantly compared to non-surgical therapy.

OBJECTIVES: Pulmonary metastasectomy (PM) is an established procedure for selected patients with metastatic head and neck cancer (HNC). Non-surgical therapy in the form of chemo- and immunotherapy and checkpoint inhibitors and radiation therapy are also treatment options. There are no randomized controlled trials comparing PM with non-surgical therapy. Here, we retrospectively compare the long-term survival of patients, undergoing PM with patients receiving non-surgical therapy. METHODS: All HNC patients with pulmonary metastases were included, if the primary HNC was treated curatively and distant metastases, apart from the lungs were excluded. The pulmonary metastases were confirmed by biopsy as metastases of the HNC primary tumour in the non-surgical therapy group. To further clarify that PM prolonged survival, a propensity score-matched analysis was performed. RESULTS: Between January 2010 and December 2020, 62 HNC patients with isolated pulmonary metastases were included in our analysis. Thirty-three underwent PM and 29 received non-surgical therapy. Histology, tumour stage and localization of the primary HNC did not differ between groups. The number of metastases, age and ASA classification did also not differ between the groups. Patients undergoing PM showed significantly better 1- (n = 31; 93.5% vs n = 19; 65.5%; P = 0.006), 3- (n = 17; 72.2% vs n = 9; 30.4%; P = 0.004) and 5-year (n = 10; 53.4% vs n = 4; 20.0%; P = 0.001) survival rates, compared to patients receiving non-surgical therapy. CONCLUSIONS: Patients with pulmonary metastatic HNC undergoing PM had a significantly better overall survival compared to patients receiving non-surgical therapy. Therefore, selected patients should undergo PM to improve survival.