Patients with pulmonary metastases from head and neck cancer and malignant melanoma benefit from pulmonary metastasectomy

Background In five years, the incidence of pulmonary metastases in patients with malignant melanoma and head and neck cancer (HNC) is approximately 10-30%. Both melanoma and HNC are aggressive tumors with poor prognoses in stage IV, with a 5-year survival of less than 20%. Immunotherapy has been increasingly used to treat both tumors. If optimal tumor mutations are present, five-year survival of 30-40% can be achieved in melanoma- and HCC patients. For patients without tumor mutations, however, survival remains poor. Pulmonary metastasectomy (PM) is established for both entities.

This study examined the long-term survival of melanoma and HNC patients with isolated pulmonary metastases who underwent PM.

Material and Methods Between 01/2014 and 01/2021, all consecutive patients with pulmonary metastatic melanoma and HNC with PM as a curative approach were included. The primary tumor in all patients was resected radically in a curative approach. We excluded patients with any other distant metastases. Disease-free interval (DFI) was measured between the primary tumor and the occurrence of pulmonary metastases. One-year, three-year, and five-year survival were calculated from PM to death.

Results 49 melanoma and 33 HNC patients met our inclusion criteria. Age did not differ within groups (p=0.41). The surgical approach did not differ between groups. Operation side differed significantly within groups (left 40.8% melanoma, 27.8% of HNC p=0.04; right 51.5% vs. 51.0% p=0.96; bilateral: 8.2% vs. 18.2% p=0.01). HNC patients were diagnosed with significantly more pulmonary metastases (1.3±0.6 vs. 2.1±1.7, p=0.01). Lesion size did not differ within groups (p=0.73). There was no in-hospital mortality. DFI differed significantly between groups (41.7±37.1 vs. 24.1±28.2; p=0.004). Patients undergoing PM for both tumor entities showed similar 1- (75.9%vs.80.1%; p=0.57), 3- (58.9%vs.63.4%; p=0.58), and 5-year (46.4%vs.40.0%; p=0.62) survival rates.

Conclusion Patients with isolated pulmonary metastases from melanoma and HNC benefited from PM. We demonstrated that 5-year survival after PM continues to exceed survival even in the era of immunotherapy and targeted therapy. PM may be the better therapeutic option for patients without optimal tumor mutations. However, only some patients are suitable for PM. Therefore all patients with pulmonary metastases should be discussed in a multi-disciplinary tumor conference to optimize the therapy of every patient with pulmonary metastases.

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Artikel online veröffentlicht:
21. August 2023