title: Diagnostic modalities for distant metastasis in head and neck squamous cell carcinoma: are we changing life expectancy?
abstract: OBJECTIVE
  To determine if the various imaging modalities for distant metastasis (DM) diagnosis alters life expectancy in head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  One hundred seventy patients (mean age, 59.1 years; male:female, 135:35) with HNSCC who developed DM were reviewed. The main outcome measures were the method of DM diagnosis and time from DM diagnosis to death while controlling for clinical parameters (age, gender, tobacco status, primary tumor site, initial TNM classification, number and site of DM, administration of palliative chemotherapy).
  
  
  RESULTS
  Tumor subsites were: 40 oral cavity, 75 oropharynx, 36 larynx, 10 hypopharynx, one nasopharynx, and eight unknown primary. Of the patients, 16.5% (28/170) had distant metastasis at presentation; the remaining 142 patients were diagnosed with DM at a median of 324 days from diagnosis. Although patients diagnosed with DM by positron-emission tomography (PET) scan were more likely to have multiple DM sites (P = .0001), there were no differences in life expectancy in patients who were diagnosed with or without PET scan (median, 185 vs. 165 days, P = .833). There were no differences in life expectancy based on age, gender, site of primary tumor, or number/site of DM. The use of palliative chemotherapy resulted in a significantly longer life expectancy (median, 285 vs. 70 days; P = .001).
  
  
  CONCLUSIONS
  Although a PET scan is more likely to diagnose multiple DM sites, there was no difference in life expectancy based on imaging modality. Patients who are symptomatic from their distant metastasis have a worse life expectancy, and palliative chemotherapy was able to increase life expectancy, even in patients who were symptomatic from the distant metastasis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA. mspector@med.umich.edu
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Spector
authors.forename: Steven B
authors.initials: SB
authors.lastname: Chinn
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rosko
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Ward
authors.forename: Vasu
authors.initials: V
authors.lastname: Divi
authors.forename: Scott A
authors.initials: SA
authors.lastname: McLean
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Moyer
authors.forename: Mark E P
authors.initials: ME
authors.lastname: Prince
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000556:secondary*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate