Among 772 patients with
HNSCC diagnosed at our hospital over 9 years, 30 patients (3.9%) had clinical evidence of
BM (24 men and 6 women; mean age: 63 years). We assessed the time interval from the primary diagnosis to BM development, symptoms attributable to BM, presence of distant
metastases to other organs, number of BM, sites of BM, morphologic changes on computed tomography (CT) images, treatment for BM, and overall survival (OS).
RESULTS: BM at the initial stage were found in 9 patients with
HNSCC (30%), and in 21 patients (70%) with
HNSCC during the course of the disease. In the later patients, the median time interval from the primary diagnosis was 11.5 months. Nineteen patients (63%) did not have BM-related symptoms, 6 (20%) had
pain, 3 (10%) had
neurologic symptoms resulting from vertebral or skull
metastases, and 2 (7%) had
hypercalcemia. Seventeen patients (57%) showed bone-exclusive
metastases, and 13 (43%) had distant
metastases in other organs. Eleven patients (37%) had monostotic
metastases (solitary BM), and 19 patients (63%) had polyostotic
metastases (multiple BM). When combined, 9 patients (30%) showed bone-exclusive and monostotic
metastases. The most commonly affected site was the thoracolumbar spine, accounting for 34% of total BM, followed by the pelvis (24%), shoulder and thorax (21%), and the extremities (17%). Notably,
metastases to bones above the clavicle (craniofacial bones and cervical spine) accounted for only 3% of all bone lesions. CT images showed variable morphologic patterns with osteolytic type in 17 patients (57%), intertrabecular in 7 (23%), osteoblastic in 4 (13%), and mixed in 2 (7%). Systematic
chemotherapy for BM was performed in 19 patients and
radiotherapy in 18. The median survival time for patients with bone-exclusive and monostotic
metastases was significantly longer than that for patients with multi-organ
metastases or polyostotic
metastases at 18.2 months vs. 5.7 months (p=0.02). Neither
chemotherapy nor
radiotherapy extended OS.
CONCLUSION: