Survival of patients with advanced head and neck cancer. Are we treating too many patients

: Survival of patients with carcinoma in head or neck is positively associated with the stage of the disease at diagnosis. A dynamic cohort of 433 patients from Oslo with head and neck carcinoma included 162 (37.4%) patients staged 4. For these patients, the prognosis was extremely serious, 5-year survival was 22.3%. In 120 of these, the primary tumour was staged 4. It was found that the presence of an advanced primary tumour (T4) in the oral cavity, oro- or hypopharynx gave the worst prognosis. Compared with NO patients, Neck metastasis, irrespective of T-stage, increased the odds ratio for mortality to the double in N1 patients, by a factor of three in N2 patients and by a factor of nearly eight in N3 patients. Owing to the serious prognosis and reduced quality of life after surgery, this is not the treatment of choice for stage 4 disease, especially when the primary tumour is advanced and localized in the oral cavity or oro/hypopharynx, or if neck metastases are present. Irrespective of treatment (surgery or irradiation) the patient's outcome (quality of life) must be evaluated against the chance of survival. 34 (8%) patients of the cohort did not receive any active treatment.