Bone metastases from squamous cell carcinoma of the head and neck

Background and Objectives: Carcinoma of the head and neck is an uncommon pr imary source of bone metastases. The increasing duration of survival of the se patients, however, increases the probability of late bone involvement. T he objective was to identify the frequency, clinical presentation, and clin ical course of metastatic disease to bone from head and neck primaries. Methods: A retrospective review was accomplished of the radiographs and nuc lear medicine studies for 363 cases of squamous cell carcinoma of the head and neck for whom radiologic studies had been performed. For those with ide ntified bone involvement, a chart review was performed to identify clinical presentation, disease course, and outcome. Results: Only approximately 1% of these patients had clinically demonstrabl e bone metastases. Eight sites of bone involvement were identified in five patients, including three pelvic, two femoral, and one each humeral, rib, a nd thoracic spine lesions. All lesions were purely lytic with motheaten or permeative borders. Time from primary tumor diagnosis to identification of metastatic disease ranged from being present at diagnosis to a maximum 3.5 years later. Time from identification of metastatic disease to patient deat h was no greater than 8 months. Conclusions: Despite the increasing overall survival of patients with these carcinomas, distant bone metastases are infrequent, but should be consider ed a possibility in any patient with a concurrent or past diagnosis of head and neck carcinoma. The very short time from discovery of bone disseminati on to death in most of these patients should be taken into consideration wh en contemplating operative intervention. J. Surg. Oncol. 2000:75:136-140. ( C) 2000 Wiley-Liss, Inc.