Clinical oncology (Royal College of Radiologists (Great Britain)) · 2026
Long-Term Outcomes and Prognostic Factors in Head and Neck Neuroendocrine Carcinoma: Implications of Multimodality Strategies and Response to Neoadjuvant Chemotherapy.
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Ghosh S, Swain M, Budrukkar A, Bal M, Ghosh-Laskar S, Nair D, Thiagarajan S, Nagar A, Patil A, Mittal N, Sinha S, Kumar A, Mohanty S, Menon N, Noronha V, Prabhash K, Vaish R, Deshmukh A, Pantvaidya G, Shetty P, Moiyadi A, Pai P, Agarwal J P
Аннотация
AIM: High-grade neuroendocrine carcinoma of the head and neck (HN-NEC) is a rare, aggressive malignancy with limited evidence on outcomes with multimodality therapy.
MATERIALS AND METHODS: This single-centre retrospective cohort study (2011-2020) analysed 48 newly diagnosed patients with poorly differentiated HN-NEC treated with curative intent. Multimodality therapy comprised neoadjuvant chemotherapy (NACT) in patients with advanced disease, followed by surgery with adjuvant (chemo)radiotherapy or definitive chemo-radiotherapy. Primary outcomes were overall survival (OS) and progression-free survival (PFS); major pathological response (MPR) was defined as ≤10% residual tumour post-NACT.
RESULTS: Median age was 45 years (IQR = 32-58); 85% had sinonasal primaries. Thirty-nine patients (81.2%) received NACT, while eight underwent primary surgery. At a median follow-up of 88.3 months, 5-year OS and PFS were 48% (95% CI: 35.2-65.3) and 36.7% (24.8-54.3), respectively. Age<50 years (p = 0.024), advanced local stage (p = 0.02), nodal metastasis (p = 0.058), and non-sinonasal primary (p = 0.02) were independent predictors of poor OS. MPR predicted significantly better 5-year OS (85.7% vs 18.5%, p = 0.019). Most patients failed at distant sites (57.7%). Only two patients (4.2%) developed brain metastases; none received prophylactic cranial irradiation (PCI). Elective nodal irradiation (ENI) significantly improved regional control (100% vs 68.6% at 5 years; p = 0.037).
CONCLUSION: Multimodality therapy integrating NACT, surgery, and radiotherapy optimises outcomes in advanced HN-NEC. Younger age, non-sinonasal origin and higher locoregional extent are poor prognostic factors, while MPR post-NACT achieves excellent survival. ENI should be considered in curative regimens. Omitting PCI appears to be safe. Future research should focus on therapeutic strategies for NACT non-responders and optimise systemic control.
MATERIALS AND METHODS: This single-centre retrospective cohort study (2011-2020) analysed 48 newly diagnosed patients with poorly differentiated HN-NEC treated with curative intent. Multimodality therapy comprised neoadjuvant chemotherapy (NACT) in patients with advanced disease, followed by surgery with adjuvant (chemo)radiotherapy or definitive chemo-radiotherapy. Primary outcomes were overall survival (OS) and progression-free survival (PFS); major pathological response (MPR) was defined as ≤10% residual tumour post-NACT.
RESULTS: Median age was 45 years (IQR = 32-58); 85% had sinonasal primaries. Thirty-nine patients (81.2%) received NACT, while eight underwent primary surgery. At a median follow-up of 88.3 months, 5-year OS and PFS were 48% (95% CI: 35.2-65.3) and 36.7% (24.8-54.3), respectively. Age<50 years (p = 0.024), advanced local stage (p = 0.02), nodal metastasis (p = 0.058), and non-sinonasal primary (p = 0.02) were independent predictors of poor OS. MPR predicted significantly better 5-year OS (85.7% vs 18.5%, p = 0.019). Most patients failed at distant sites (57.7%). Only two patients (4.2%) developed brain metastases; none received prophylactic cranial irradiation (PCI). Elective nodal irradiation (ENI) significantly improved regional control (100% vs 68.6% at 5 years; p = 0.037).
CONCLUSION: Multimodality therapy integrating NACT, surgery, and radiotherapy optimises outcomes in advanced HN-NEC. Younger age, non-sinonasal origin and higher locoregional extent are poor prognostic factors, while MPR post-NACT achieves excellent survival. ENI should be considered in curative regimens. Omitting PCI appears to be safe. Future research should focus on therapeutic strategies for NACT non-responders and optimise systemic control.