title: Brain metastasis from nonnasopharyngeal head and neck squamous cell carcinoma: A case series and review of literature.
abstract: BACKGROUND
  Brain metastasis from primary head and neck squamous cell carcinoma (HNSCC) is infrequent and probably under-reported thereby leading to paucity of information.
  
  
  METHODS
  Archives of two institutes in India were studied from 2005 to 2013 and relevant information regarding patient demographics, treatment details, and follow-up was obtained for patients having brain metastasis (BM) from HNSCC. Data were analyzed using SPSS software version 20 (IBM Corporation, NY, USA).
  
  
  RESULTS
  Metastasis to the brain was detected in 17 patients with an HNSCC primary. The median age for diagnosis of index primary was 55 years (range (R) - 32-71 years) with 88% (15/17) being male. Oral cavity was the most common site of primary disease with 35% (6/17) followed by larynx (24%), oropharynx (18%), and hypopharynx (18%). The median stage at presentation was IVA (47%) and two (12%) were metastatic to the brain at presentation. Human papillomavirus analysis was not available for any of the patients. Neurological symptoms were complained of in 94% patients. The median BM-free-interval was 15 months (R - 1-67 months, SE ± 5.2). While 88% had multiple brain metastases, 82% also had extracranial metastasis and in 53% of patients, the index primary was not controlled. The median overall survival of all patients after the development of BM was 2 months (R - 0.5-6 months, SE ± 0.4).
  
  
  CONCLUSIONS
  BM in HNSCC is mostly multiple, associated with extracranial metastasis and can occur in patients without locoregional relapse or residual disease and carries a dismal outcome.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.affiliation: Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Agarwal
authors.affiliation: Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
authors.forename: Prahlad H
authors.initials: PH
authors.lastname: Yathiraj
authors.affiliation: Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
authors.forename: Prasad
authors.initials: P
authors.lastname: Tanawade
authors.affiliation: Department of Radiotherapy, Navoday Cancer Hospital and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Panday
authors.affiliation: Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.affiliation: Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome