Metastatic disease in head & neck oncology

Paolo Pisani, Mario Airoldi, Anastasia Allais, Paolo Aluffi Valletti, Mariapina Battista, Marco Benazzo, Roberto Briatore, Salvatore Cacciola, Salvatore Cocuzza, Andrea Colombo, Bice Conti, Alberto Costanzo, Laura Della Vecchia, Nerina Denaro, Cesare Fantozzi, Danilo Galizia, Massimiliano Garzaro, Ida Genta, Gabriela Alejandra Iasi, Marco KrengliVincenzo Landolfo, Giovanni Vittorio Lanza, Mauro Magnano, Maurizio Mancuso, Roberto Maroldi, Laura Masini, Marco Carlo Merlano, Marco Piemonte, Silvia Pisani, Adriele Prina-Mello, Luca Prioglio, Maria Gabriella Rugiu, Felice Scasso, Agostino Serra, Guido Valente, Micol Zannetti, Angelo Zigliani

Research output: Contribution to journalArticlepeer-review

Abstract

The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.

Keywords

  • chemotherapy
  • distant metastasis
  • head and neck oncology
  • immunotherapy
  • nanomedicine
  • radiotherapy

ASJC Scopus subject areas

  • Otorhinolaryngology

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