title: How intensive should radiotherapy for head and neck cancer with synchronous distant metastases be? Review of cases.
abstract: OBJECTIVE
  Given the differences in treatment objectives among oncologists and complexities of standards of therapy for advanced head and neck cancer (HNC), we sought to determine whether HNC patients with simultaneous distant metastases (M1) benefit from aggressive therapeutic intervention.
  
  
  METHODS
  Among the 1,988 patients diagnosed with HNC during a 22-year period, 7 patients with synchronous M1 tumors were identified. Of these individuals, 4 were treated with a prolonged course of radiotherapy for HNC (group A) and 3 were not (group B).
  
  
  RESULTS
  The median survival and 60-day mortality rate in group A were 14 months and 0%, respectively, whereas the corresponding observations for group B were 5.5 months and 50%. No difference in HNC stage or M1 extent was present between the 2 groups. The patients composing group A were older than those in group B.
  
  
  CONCLUSIONS
  These data suggest that some benefit may be obtained by the application of a full course of irradiation for HNC with synchronous M1 disease. The practice of intensive radiotherapy for this particular complicated neoplastic condition needs to be reviewed, considering the health care reform and emphasis on cost-effectiveness in the near future.
authors.affiliation: Division of Therapeutic Radiology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA. fampil@lsuhsc.edu
authors.forename: Federico L
authors.initials: FL
authors.lastname: Ampil
authors.forename: David D
authors.initials: DD
authors.lastname: Kim
authors.forename: Ghali E
authors.initials: GE
authors.lastname: Ghali
authors.forename: Roxana G
authors.initials: RG
authors.lastname: Baluna
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015331:Cohort Studies; D017050:Episode of Care; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011829:Radiation Dosage; D011878:Radiotherapy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome