Local brain therapies associated with reduced mortality in HNSCC patients with brain metastasis

This retrospective cohort analysis included 201 patients diagnosed with head and neck squamous cell carcinoma (HNSCC) and brain metastasis (BM) across three tertiary care institutions. The study compared various local therapies—including whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and surgical intervention with post-operative radiotherapy—against no treatment. The primary outcome assessed survival following BM diagnosis, while secondary outcomes included incidence rates, metastasis distribution, and mortality risks.

The incidence rate of brain metastasis was 1.1%. The median interval from treatment initiation to BM diagnosis was 2.5 years. Distribution of intracranial metastases showed one metastasis in 65 cases, two or three in 84 cases, and four or more in 52 patients. Localization involved the supratentorial region in 130 patients and both supratentorial and infratentorial regions in 56 patients. All patients succumbed within two years, with a median survival time of 3 months.

Patients receiving WBRT or SRS alone demonstrated a reduced mortality risk compared to no treatment, with a hazard ratio of 0.72 (95% CI: 0.53-0.98). Those undergoing surgical intervention with post-operative radiotherapy also showed reduced mortality risk, with a hazard ratio of 0.64 (95% CI: 0.43-0.95). Safety data, adverse events, and tolerability were not reported in the study.

Brain metastasis in HNSCC is a rare occurrence, often correlated with lung metastasis. Local therapy for brain metastases, primarily involving WBRT, whether administered alone or alongside surgical interventions, was found to be associated with modest prolonged survival durations. As an observational study, these results describe associations rather than establishing causality. Clinicians should interpret these findings within the context of the study's limitations and the rarity of the condition.