# Recurrent/metastatic relapse after definitive treatment for HNSCC: timing, patterns, and survival

## TL;DR

This study examines how and when head and neck cancers return after treatment, finding that certain treatment types and cancer types lead to faster relapse and worse survival.

## Contribution

The study identifies high-risk treatment groups and cancer subtypes associated with rapid recurrence and poor survival in HNSCC.

## Key findings

- Patients treated with CRT or surgery plus CRT had shorter time to recurrence and worse survival compared to others.
- HPV+ oropharynx cancer patients had longer survival after recurrence compared to HPV- patients.
- De novo metastatic patients made up 22% of the study population and had distinct clinical characteristics.

## Abstract

Timing and outcomes of recurrence after definitive therapy for HNSCC are incompletely understood.

This study included patients in a nationwide EHR-derived de-identified database who received systemic therapy for R/M HNSCC. Time from definitive treatment to R/M systemic therapy initiation (TTRM), and overall survival (OS) from R/M systemic therapy initiation, were estimated and compared between patients stratified by cancer site and prior definitive treatment modality.

Of 7657 patients receiving R/M therapy, the median age was 65 (IQR 58-72), 77% male, 74% white, 79% with smoking history, and 79% ECOG PS 0-1. 1684 (22%) patients had no recorded prior definitive therapy (de novo metastatic); of the remaining 5973 patients, most common definitive treatment types were radiation alone (RT only; 43%), followed by surgery plus radiation (Surg + RT; 21%), surgery alone (Surg only; 16%), chemoradiation (CRT; 14%), and surgery plus chemoradiation (Surg + CRT; 6%). Patients treated with high-risk treatment types (Surg + CRT, CRT) had higher disease stage at presentation, shorter TTRM (median 6–7 vs 17–19 months), and shorter OS from R/M treatment to death (median 8 vs 12 months) compared to patients in low-risk treatment groups (RT only, Surg + RT, Surg only). Patients with HPV+ oropharynx cancer had numerically longer TTRM (median 17 vs 13 months, p = 0.4309) and significantly longer OS (median 18 vs 10 months, p < 0.001) than HPV- cancers.

Patients with locoregionally advanced HNSCC treated with CRT and surgery plus CRT represent a high-risk cohort with rapid R/M disease and poor survival, who need improved therapeutic options.