Spinal epidural compression in head and neck cancer. Report of five cases

Spinal metastasis in head and neck cancer

Background

The incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia. Notwithstanding advances in surgery and radiotherapy over the past several decades, the 5-year survival rate for head and neck cancer has stagnated and remains at 50–55%. This is due, in large part, to both regional and distant disease spread, including spinal metastasis. Spinal metastasis from head and neck cancer is rare, has a poor prognosis and can significantly impede end-stage quality of life; normally only palliative care is given.

This study aims to conduct a systematic review of the evidence available on management of spinal metastasis from head and neck cancer and to use such evidence to draw up guiding principles in the management of the distant spread.

Methods

Systematic review of the electronic literature was conducted regarding the management of spinal metastasis of head and neck malignancies.

Results

Due to the exceptional rarity of head and neck cancers metastasizing to the spine, there is a paucity of good randomized controlled trials into the management of spinal metastasis. This review produced only 12 case studies/reports and 2 small retrospective cohort studies that lacked appropriate controls.

Conclusion

Management should aim to improve end-stage quality of life and maintain neurological function. This review has found that radiotherapy +/− medical adjuvant is considered the principle treatment of spinal metastasis of head and neck cancers.

There is an absence of a definitive treatment protocol for head and neck cancer spinal metastasis. Our failure to find and cite high-quality scientific evidence only serves to stress the need for good quality research in this area.

Residual or recurrent head and neck cancer presenting with nerve root compression affecting the upper limbs

Nerve root and spinal cord compression are oncological emergencies that require early detection and prompt management. These phenomena are most frequently diagnosed in patients with haematogenous metastases from lung, breast and prostate cancers and are rarely seen in patients with squamous cell cancer of the head and neck (SCCHN). SCCHN tends to spread by direct extension and lymphatic metastasis, with haematogenous dissemination occurring late in the natural history of the disease. In this paper, we report three patients with residual or relapsed SCCHN who presented with symptoms and signs of nerve root compression affecting the upper limbs caused by locoregional lymphatic spread of disease.

Neurologic complications of solid tumors

This article reviews the neurologic complications of the most common solid tumors, including lung, breast, gastrointestinal, genitourinary, gynecologic, head and neck cancers, melanoma and sarcomas. As systemic therapy improves for many of these tumors, patients are surviving longer and the incidence of neurologic complications is increasing.