Clinical Investigation
Small Cell Carcinoma of the Head and Neck: The University of Miami Experience

https://doi.org/10.1016/j.ijrobp.2008.08.014Get rights and content

Purpose

To describe the University of Miami experience in the treatment of small cell carcinoma of the head and neck.

Methods and Materials

A total of 12 patients with nonmetastatic small cell carcinoma of the head and neck were treated between April 1987 and September 2007. Radiotherapy was the primary local treatment modality for 8 patients.

Results

Of the 12 patients, 8 had died after a median follow-up of 13 months. The 4 patients who were alive were followed for a median of 14 months. The Kaplan-Meier estimate of the proportion of small cell head-and-neck cancer patients surviving to 1 and 2 years was 63% and 26%, respectively. The percentage of patients remaining disease free at 1 and 2 years was 71% and 44%, respectively. The patients with tonsil/parotid gland cancer had significantly greater disease-specific survival compared with the other patients. The median survival time was 30 months in the tonsil/parotid group compared with 15.2 months in the other group (patients with small cell carcinoma of the sinonasal cavity, nasopharynx, and larynx). A total of 4 patients developed recurrence, 3 of whom had a distant failure component. The treatment modality was not associated with a difference in disease-specific survival. The 1-year disease-specific survival rate was 73% in the radiotherapy or radiotherapy/chemotherapy group compared with 67% in the other group.

Conclusion

Radiotherapy with or without chemotherapy is a reasonable alternative to surgery for patients with small cell carcinoma of the head and neck. Patients with tonsillar or parotid small cell carcinomas did better than other sites. More aggressive treatment might be warranted for patients with sinonasal carcinoma. The outcome, however, continues to be suboptimal, and more effective therapy is needed because most patients had a component of local and distant failure.

Introduction

Small cell carcinoma of the head and neck is a rare neuroendocrine tumor (1) that can arise from multiple anatomic subsites and carries a poor prognosis. Although some differences in the clinical behavior of tumors arising from different subsites may exist, it is known that small cell carcinoma of the head and neck is aggressive and has a propensity for distant and/or regional spread. Therapeutic management can include surgery, radiotherapy, chemotherapy, or some combination of these modalities. Because of the rarity of these tumors and the extremely small number of single-institution experiences or case reports, no firm recommendations or treatment guidelines can be strictly followed. It is very important to continue to report single-institution experiences of small cell carcinoma of the head and neck, thus disseminating any available information on the treatment and its outcomes of this very rare neuroendocrine tumor. The purpose of our retrospective study was to describe the experience of the University of Miami in treating small cell carcinoma of the head and neck during a 20-year period.

Section snippets

Methods and Materials

Our institutional review board approved the study. A total of 12 patients with primary nonmetastatic, histopathologically documented, small cell carcinoma of the head and neck involving the parotid gland, oropharynx, nasopharynx, sinonasal cavity, or supraglottic larynx were treated at the University of Miami between April 1987 and September 2007. All patients had undergone a complete workup to rule out distant metastasis or other primary site metastases to the head-and-neck area. The

Results

The demographics, disease characteristics, and treatment received are summarized in Table 1. Of the 12 patients, 7 were men and 5 were women. The median age at presentation was 69.5 years (range, 49–85). Of 10 patients, with a known stage, 8 (80%) had positive regional adenopathy at diagnosis.

The 11 patients who underwent radiotherapy were treated with 6-MV photons, with once-daily radiation dose of 1.8 or 2.0 Gy/fraction. The total dose was 45–70.2 Gy (median, 64.8). No patient received

Discussion

Extrapulmonary small cell carcinomas comprise 2.5–5% of all small cell carcinomas (3). The first case of small cell carcinoma of the head and neck was reported by Olofsson and van Nostrand (4) in 1972 and involved the larynx. Small cell carcinomas of the head and neck are generally considered very aggressive, with a great propensity for local infiltration and regional and diffuse distant metastases.

At diagnosis, more than one-half of patients present with a nodal mass. Moisa (5) reported a 59%

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  • Small cell and large cell neuroendocrine carcinoma of the larynx: A comparative analysis

    2019, Cancer Treatment Reviews
    Citation Excerpt :

    Finally, 141 articles describing 273 patients were selected for systematic review [2,4,5,7,8,13,15–149] (Fig. 2). Out of 273 poorly differentiated NECs of the larynx reported between 1972 and 2019, 230 cases were of SCNEC histology (84.2%, reported in 128 publications: [2,5,7,8,15–63,65–90,92,94–103,105–112,114,116–118,120–139,141,143,145–147,149]) and 43 cases were LCNECs (15.8%, reported in 20 publications: [4,13,64,82,91,93,104,113,115,118,119,124,125,137,138,140,142,144,146,148]). The number of relevant publications and the number of described SCNEC cases varied somewhat through the studied period.

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Conflict of interest: none.

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