Survival and treatment outcomes in head and neck cancer patients with brain metastases (HNC-BM): A national analysis.

Abstract

e14009 Background: Brain metastases (BM) in head and neck cancer (HNC) are uncommon, occurring in 0.03–0.4% of cases and linked to poor survival outcomes. While multimodal therapy advancements have improved survival in other metastatic cancers, limited data exist on patients with BM from HNC. This study evaluates the survival and treatment outcomes of HNC patients with BM using the National Cancer Database (NCDB). Methods: This retrospective cohort study analyzed data from 409,723 HNC patients in the NCDB (2010–2022). Kaplan-Meier analyses were used to estimate median overall survival (OS), and Cox proportional hazard models were applied to identify predictors of OS, adjusting for age, sex, race, income, insurance type, facility type, and treatment modalities. Results: Of 137,855 stage-IV HNC patients, 646 (0.46%) were diagnosed with BM. Most patients with BM were male (70.1%), White (76%), and > 60 years-old (61.5%). The majority were Medicare/Medicaid-insured (61.3%), 26% were privately insured and 9% uninsured. Compared to patients without BM, those with BM had lower rates of private insurance (25.8% vs. 39.7%, P < 0.001) and surgical intervention (13.6% vs. 56.5%, P < 0.001), but higher utilization of palliative care (20.6% vs. 2.4%, P < 0.001). The median OS for patients with BM was 5.59 months (IQR: 5.13-6.64), significantly shorter than 57 months (IQR: 55.98-58.02) in those without BM. Survival rates for patients with BM at 6-, 12-, and 24-months were 47.8%, 29.2%, and 14.6%, respectively. Multivariable Cox proportional hazard analysis identified surgical intervention (HR = 0.67, 95% CI: 0.53–0.86, P = 0.002) and systemic therapy (HR = 0.45, 95% CI: 0.38–0.53, P < 0.001) as independent predictors of improved OS. Patients treated with stereotactic radiosurgery had a better median OS (9.9 months) compared to whole-brain radiation therapy (WBRT, 6.9 months). The difference in radiation type, however, was non-significant for OS (P = 0.13), suggesting a selection bias of WBRT for patients with poor prognosis and/or functional status. Advanced age (≥70 years; HR 1.42, 95% CI: 1.15–1.75, P = 0.001) and low income ( < $46,276; HR 1.50, 95% CI: 1.16–1.94, P = 0.002) were also associated with worse OS. Conclusions: Patients with BM from HNC have poor survival outcomes, with a median OS of 5.59 months, significantly lower than those without BM. Surgical intervention and systemic therapy were associated with improved OS, while advanced age and low income predicted worse outcomes. Cox proportional hazard model in patients with brain metastases (BM) from head and neck cancer (HNC). Variable HR (95% CI) P Age18-5960-6970+ Ref1.27 (1.04-1.55)1.42 (1.15-1.75) -0.0180.001 SurgeryNoYes Ref0.67 (0.53-0.86) 0.002 Systemic TherapyNoYes Ref0.45 (0.38-0.53) <0.001 Radiation TherapyWBRTSRSNone Ref0.76 (0.54-1.08)0.88 (0.70-1.10) 0.1300.261