Brain metastasis in head and neck cancer: an analysis of 201 cases

Objective: To elucidate the clinicopathological characteristics and survival trajectories of patients with head and neck squamous cell carcinoma (HNSCC) who developed brain metastasis (BM). Methods: This retrospective analysis enrolled patients diagnosed with HNSCC and BM from three tertiary care institutions. Survival following the diagnosis of BM and the patterns of BM were examined. Results: A total of 201 HNSCC patients with BM were analyzed, revealing an incidence rate of 1.1%. The median interval from the initiation of treatment to the diagnosis of BM was determined to be 2.5 years. The distribution of intracranial metastases was as follows: one metastasis in 65 cases, two or three in 84 cases, and four or more in 52 patients. Brain metastases were predominantly localized to the supratentorial region in 130 patients, while involvement of both supratentorial and infratentorial regions occurred in 56 patients. The majority of patients reported significant discomfort. All patients succumbed within two years of the initial BM diagnosis, with the median survival time of 3 months. In Cox model analyses, patients receiving whole-brain radiotherapy or stereotactic radiosurgery alone or those undergoing surgical intervention in conjunction with post-operative radiotherapy exhibited a reduced mortality risk compared to those receiving no treatment, with hazard ratios of 0.72 (95% confidence interval: 0.53-0.98) and 0.64 (95% confidence interval: 0.43-0.95), respectively. Conclusion: Brain metastasis in patients with head and neck squamous cell carcinoma is a rare occurrence, often correlated with lung metastasis. Local therapy for brain metastases, primarily involving whole-brain radiotherapy, whether administered alone or alongside surgical interventions, was found to be associated with modest prolonged survival durations.