Natural History And Prognostic Factors Of Head And Neck Cancer Patients With Bone Metastases: A Retrospective Italian Study

Background: We performed a retrospective survey to study the natural history and the prognostic factors of patients (pts) with bone metastases (BMs) from head and neck cancers (HNCs). Methods: Clinical records of pts treated at 11 oncologic centers across Italy were retrieved. All pts were selected on the base of BMs either at diagnosis or at subsequent time points. Pts with a diagnosis of nasopharyngeal carcinoma (NPC) were analyzed separately. The time-to-first bone metastasis was calculated from initial diagnosis. The skeletal-related events (SREs) (fractures, medullary compression, hypercalcemia) were recorded from the date of BMs diagnosis. Results: From 2008 to 2016, 192 HNC pts with BMs (64 NPCs and 128 other-HNCs) were collected. Median time to first BM was 9 and 12 months for NPCs and other-HNCs, respectively. SREs occurred in 9% and 27% NPC and other-HNC pts, respectively. Pts received specific antineoplastic treatments (92%) or best supportive care (8%). Median progression free survival (PFS) and overall survival (OS) were 11 and 25 months in NPC-BM pts and only 5 and 6 months in other-HNC-BM pts, respectively. SRE did not affect the pt prognosis except for hypercalcemia that was associated with a poorer prognosis (not significant). Biphosphonates and/or denosumab were administered in 34% NPC and 33% other-HNC pts, respectively. The administration of bone-directed therapies, also including radiation therapy and surgery on BMs, was associated with a better survival at univariate analysis in both NPC and other-HNC (Hazard Ratio [HR]: 0.43, 95% confidence interval [CI] .008-.237, p