Advances in radiation therapy and the introduction of multidisciplinary care teams are being credited for a dramatic improvement in the prognosis of metastatic head and neck cutaneous squamous cell carcinoma (HNcSCC).

Survival rates for the condition have doubled in the last three decades, despite patients generally being older and presenting with more adverse prognostic factors on diagnosis, according to figures from the Sydney Head and Neck Cancer Institute at the Chris O’Brien Lifehouse.

A review of outcomes for 401 patients with HNcSCC treated at the Institute since 1987 showed that five-year disease specific survival rates increased from 57% in the period 1987-1996 to 88% during 2007-2016. Overall there was a 50% reduction in disease specific mortality rate each decade after adjusting for other confounding factors.

The increases in survival were particular marked for patients who had received surgery followed by radiotherapy, the study authors said.

The improvements occurred despite the number of patients  aged over 75 rising from 30% to 53% over the same period. Patients with HNcSCC also tended to have more involved nodes and soft tissue deposits.

Writing in the Australia and NZ Journal of Surgery, study investigators, led by Dr Tharsiga Gnanasekaran, noted that treatment approaches to HNcSCC had evolved over the last three decades, with the notable introduction of multidisciplinary team care from the year 2000 onwards and a focus on providing targeted radiotherapy.

This was reflected in the study findings showing that use of adjuvant radiotherapy has declined from 84% to 64% but the average dose had increased. They also noted that surgical treatment approaches had become more selective and tissue sparing, with a significant reduction in rates of neck dissection.

The findings were reassuring given that Australia has the highest incidence of cutaneous SCC in the world, with more than 387 cases per 100 000, they wrote.

Medical advances have enabled us to treat older patients and more advanced metastatic HNcSCC and their prognosis appears to have improved over the past 30 years.