S Ghosh, M Swain, A Budrukkar, M Bal, S Ghosh-Laskar, D Nair, S Thiagarajan, A Nagar, A Patil, N Mittal, S Sinha, A Kumar, S Mohanty, N Menon, V Noronha, K Prabhash, R Vaish, A Deshmukh, G Pantvaidya, P Shetty, A Moiyadi, P Pai, J P Agarwal
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.
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.