Local ablative treatments of oligometastases from head and neck carcinomas
A partir d'une revue systématique de la littérature (98 articles), cette étude analyse le rôle de la chirurgie et de la radiothérapie corporelle ablative stéréotaxique dans le traitement d'oligométastases ayant pour origine un carcinome de la tête et du cou
Background : median survival for recurrent/metastatic (unknown poly/oligometastatic status) head and neck cancer patients (HNSCC) is ten months with best systemic treatment. Metastatic ablation shows promising results in selected patients with several tumor types. We aimed to assess the role of surgery and stereotactic ablative body radiotherapy (SABR) with respect to survival in HNSCC. Material and methods : published data on metastatic HNSCC treated ablatively were analyzed. Results : five-year survival rates after pulmonary/liver metastasectomy exceed 20% in selected patients. Two-year survival after lung SABRT of metastasectomy yields 35%. Interesting data on survival and tolerance are reported in other metastatic sites. Conclusion : Surgery yields the best level of evidence. However, non-invasive SABR is efficient and well-tolerated in lung/liver, bone and other metastatic locations. Systemic treatment may be given sequentially with ablative treatments, or omitted in well-identified situations. Proper patient selection for local ablative treatment and optimal therapeutic sequence should be assessed in randomized trials.
http://www.sciencedirect.com/science/article/pii/S104084281400016X