Frequency and distribution pattern of distant metastases in patients with ENT tumors and their consequences for pretherapeutic staging

PURPOSE: To address the following questions: which parameters influenced the frequency of distant metastases in patients with locally advanced ear-nose-throat (ENT) tumors, which was the distribution pattern of metastases, and what were the diagnostic consequences for pretherapeutic staging? PATIENTS AND METHODS: 600 patients (526 men, 76 women, median age 56 years) with ENT tumors (squamous cell carcinoma histology) were studied retrospectively. The distribution of primary tumor site and stage (AJCC) was as follows: oropharynx: n = 161 (26.8%), hypopharynx: n = 187 (31.2%), oral cavity: n = 89 (14.8%), larynx: n = 118 (19.7%), cancer of unknown origin: n = 13 (2.2%), others: n = 32(5.3%), I: n = 24 (4%), II: n = 49 (8.2%), III: n = 89 (14.8%), IV: n = 438 (73%). 270 patients (45%) received radiochemotherapy, 330 (55%) postoperative radiotherapy. The following parameters were analyzed in association with distant metastases: tumor localization, T- and N-category, primary treatment, local tumor control, and second neoplasms. RESULTS: 114/600 patients (19%) developed distant metastases, 29/600 (4.9%) at presentation, 50% within 9.3 months after diagnosis of the primary tumor. Distant metastases were most frequent in stage IV (24.2%), carcinoma of the hypopharynx (25.7%), local recurrence (24.3%), and second neoplasm (31.7%) with the following distribution pattern: pulmonary 61/114 (53.5%), pleural 15/114 (13.1%), osseous 45/114 (39.5%), hepatic 14/114 (12.3%), cerebral 8/114 (7%), cutaneous 14/114 (12.3%). 34/114 patients (29.8%) presented monotopic, 80/114 (70.2%) polytopic metastases. 82/600 (13.6%) patients additionally had second neoplasms, 20 corresponding with synchronous or metachronous bronchial tumors. CONCLUSION: With locally advanced ENT tumor stage IVa/b, carcinoma of the hypopharynx, local recurrence or second neoplasms, at least a pretherapeutic CT of the thorax should be performed because every seventh patient (88/600) developed metastases or second primary tumors within the thoracic space during the course of disease. Regarding the side effects and costs of curative therapy, the definition of generally accepted guidelines for the systemic staging of locally advanced ENT tumors should be undertaken.