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Moya-Plana A, Aupérin A, Obongo R, Baglin A, Ferrand FR, Baujat B, Saroul N, Casiraghi O, Vergez S, Herman P, Janot F, Thariat J, Vérillaud B, de Gabory L. Oncologic outcomes, prognostic factor analysis and therapeutic algorithm evaluation of head and neck mucosal melanomas in France. Eur J Cancer 2019; 123:1-10. [PMID: 31670075 DOI: 10.1016/j.ejca.2019.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/03/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established. MATERIAL & METHODS Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed. RESULTS In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor. CONCLUSION Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.
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Affiliation(s)
- A Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.
| | - A Aupérin
- Biostatistics Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - R Obongo
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - A Baglin
- Department of Pathology, Lariboisière Hospital, Paris, France
| | - F R Ferrand
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France; Medical Oncology Department, HIA Begin, Saint Mandé, France
| | - B Baujat
- Head and Neck Surgery Department, Tenon Hospital, Paris, France
| | - N Saroul
- Head and Neck Surgery Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - O Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Vergez
- Head and Neck Surgery Department, Toulouse University Hospital Center, Toulouse, France
| | - P Herman
- Head and Neck Surgery Department, Lariboisière Hospital, Paris, France
| | - F Janot
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - J Thariat
- Radiation Oncology Department, Baclesse Cancer Center, Caen, France
| | - B Vérillaud
- Head and Neck Surgery Department, Lariboisière Hospital, Paris, France
| | - L de Gabory
- Head and Neck Surgery Department, Pellegrin Hospital, Centre Michelet, Bordeaux, France
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