Our search protocol retrieved 14 articles published from 1965 to 2009 (Table, , , , and ). Reported cases of spinal metastasis with primary head and neck cancers were collected, identifying 28 patients in total. Two studies were retrospective cohort studies, and 12 were case studies/reports. Studies varied in terms of location, patient ages and cancer types. Nineteen patients had squamous cell carcinoma (SCC) (Table
), two had acinic cell carcinoma (Table
), three had adenoid cyctic carcinoma (ACC) (Table
), and four had carcinoma ex pleomorphic adenoma (Table
). Age (at the time of diagnosis) varied from 28 to 80 (Table, , and ).
In terms of primary site management, surgical excision was performed in fifteen patients, with five patients receiving adjuvant RT, and one patient receiving adjuvant CT. Two patients received RT and CT, one patient received CT as well as chemoradiotherapy (CR), and three patients received RT only. RT was administered to a total of ten patients, and CT was given to four patients in total. Primary site management were not reported in six patients. Cisplatin and 5-fluorouracil (5-FU) were used as the chemotherapeutic agents (Table, , and ).
Spinal metastasis were most commonly seen in the thoracic region, with seventeen patients. Cervical spine lesions were seen in eight patients, and lumbar spine lesions were seen in twelve patients. Most commonly reported spinal symptoms were back pain and weakness, with sixteen patients reporting each of the symptoms. Three patients experienced numbness. Spinal symptoms were not stated in three patients (Table, , and ).
Excision of the spinal metastasis was performed in three patients, and two of the three patients received adjuvant radiotherapy. Decompression was performed in seven patients, and four patients were given RT and CT. Twenty-two patients in total received radiotherapy, five received chemotherapy, and seven received steroids. In terms of chemotherapy, cisplatin and 5-FU were used in conjunction in four patients, and one patient received epirubicin on top of the two agents. Etoposide was administered in one patient, and another patient received paclitaxel and carboplatin (Table, , and ).
Fifteen patients reported improved symptoms after intervention, and ten reported no response or worsened symptoms. Outcomes of intervention were not given in three patients. Within the ten patients with no response or worsened symptoms, two patients received decompression laminectomy only, and another patient received decompression and RT. RT, CT and steroids were given to one patient, and another patient received RT and steroids. Two patients received RT only, and one received CT only. One patient refused surgical procedures and RT, therefore received steroids only (Table, , and ).
Seventeen patients were found to have other metastasis. Eight patients had metastasis to the skull, and another patient to the acetabulum. Lung metastasis was seen in six patients, regional metastasis including lymph nodes were seen in five patients, and two patients had metastasis in multiple foci. Five patients had no metastasis other than to the spine, and were not reported in six patients (Table, , and ).
Mortality rate was 89.5% in patients with head and neck SCC as primary cancer, with variable follow-up periods (few months to few years). The mean time from treatment of spinal metastasis to mortality was 3.4
months in reported cases. Patient 14 from Lee et al. [32
], and patient 18 from Tornwall et al. [19
], are not included in the mean value, as the authors have failed to state numerative figures. Mean time from primary cancer to spinal metastasis was 15.0
months. Patient 2 and 4 from Ampil et al. [31
], have not been included because these values are not stated. Cause of death is not given in the majority, but three have died from disseminated disease, and one from sepsis (Table
Within SCC group, two patients from Ampil et al. [31
], (2 and 4) were alive at different follow-up periods (5
months and 88
months), and both had “metachronous” presentation of primary cancer and spinal metastasis, but the exact time frame is not given. The other two patients from Ampil et al. [31
], (1 and 3) had “synchronous” presentation of the primary and the metastasis, and both have died at 4
months and 1
month, respectively (Table
There were only three other mortalities in non-SCC cancers. These were patient 2 in Preciado et al. [20
], and patients 1 and 2 in Thomas et al. [30
]. However, patient 1 in Thomas et al. [30
], died of gastrointestinal haemorrhage from benign gastric ulcer, unrelated to the cancer (Table and ). The causes of death in the other two are not given. There were no mortalities seen in acinic cell carcinoma. Mean time from primary cancer to metastasis was 9.4
years in ACC, 38
months in acinic cell carcinoma, and 20.3
years in pleomorphic adenoma (Table and ).