Circulating Tumour Cells in locally advanced head and neck cancer: Preliminary report about their possible role in predicting response to non-surgical treatment and survival

Background and purpose: The mechanism of dissemination of locally advanced head and neck cancer (LAHNC) is far to be resolved. Circulating Tumour Cells (CTC) have been identified as a prognostic factor in metastatic breast and prostate cancer. This prospec- tive multi-centric analysis studied the possible role of CTC identification in LAHNC. Materials and methods: CTC were searched in 73 patients with LAHNC (oropharynx, n = 39; nasopharynx, n = 10; larynx, n = 10; paranasal sinuses, n = 6, of whom 3 with sinonasal undifferentiated carcinoma, SNUC; hypopharynx, n = 5; oral cavity, n = 3). All of them (apart from SNUC) had squamous cell cancers. The relationship between CTC positivity and other clinical prognostic factors has been investigated. Response to treatment and sur- vival has been related with changes in CTC number during the treatment. Results: CTC were frequently identified in oro- and hypopharyngeal cancer and in SNUC. They were more frequent in stage IV than in stages I-III disease (18% versus 6%, p =N S (not significant)). Partial or complete response (CR) was related with the absence or disap- pearance of CTC during treatment (p = 0.017). A decrease in the CTC number or their absence throughout the treatment seems also related with non-progressive disease, after both complete or incomplete remission and with the proportion of patients alive and NED (no evidence of disease) (p = 0.009).