Rota Simone, Buriolla Silvia, Franza Andrea, Cavalieri Stefano, Bergamini Cristiana, Alfieri Salvatore, Nuzzolese Imperia, Colombo Elena, Ottini Arianna, Lombardi Stocchetti Benedetta, Massa Giacomo, Caraceni Augusto, Licitra Lisa, Resteghini Carlo
Department of Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milano, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.
J Cancer Res Clin Oncol. 2025 Aug 29;151(8):240. doi: 10.1007/s00432-025-06297-5.
Systemic anticancer treatments (SACTs) are used in advanced cancer stages to control disease and improve survival. However, their use at the end of life (Eol) can lead to side effects. This study aims to assess the clinical implications of SACTs near the Eol in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC).
This is an observational retrospective study conducted at Fondazione IRCCS Istituto Nazionale dei Tumori di Milano. R/M HNSCC patients treated from 2016 to 2024 were included and classified based on the timing of their last SACT relative to death: within 30 days (Cohort 1), and more than 30 days before death (Cohort 2). Cohort 1 was further subdivided into treatments given 15–30 days (1a) or within 14 days (1b) before death. We assessed performance status, survival outcomes, time from last therapy administration to death, fatal acute adverse events, and palliative care referral rates.
One hundred fifty-five patients were evaluable for the analysis. Patients receiving last anticancer therapy within 30 days of death exhibited worse overall survival compared to those who received their last treatment earlier (HR = 0.69; 95% CI 0.48–1.00; = 0.047). Fatal acute events occurred in 31% of cases, with respiratory failure and major bleeding as leading causes.
SACTs within 30 days of death correlates with worse prognosis and more aggressive disease. Major bleeding may be treatment-related when administered within 14 days of death. These findings emphasize the need for careful patient selection and early palliative care integration.
The online version contains supplementary material available at 10.1007/s00432-025-06297-5.
全身抗癌治疗（SACTs）用于晚期癌症阶段以控制疾病并提高生存率。然而，在生命末期（Eol）使用它们可能会导致副作用。本研究旨在评估复发性/转移性头颈部鳞状细胞癌（R/M HNSCC）患者在生命末期附近进行SACTs的临床意义。
这是一项在米兰国立肿瘤研究所IRCCS基金会进行的观察性回顾性研究。纳入了2016年至2024年接受治疗的R/M HNSCC患者，并根据其最后一次SACT相对于死亡的时间进行分类：在30天内（队列1），以及在死亡前30天以上（队列2）。队列1进一步细分为在死亡前15 - 30天（1a）或14天内（1b）给予的治疗。我们评估了体能状态、生存结果、从最后一次治疗给药到死亡的时间、致命急性不良事件和姑息治疗转诊率。
155例患者可纳入分析。与那些更早接受最后一次治疗的患者相比，在死亡前30天内接受最后一次抗癌治疗的患者总体生存率更差（HR = 0.69；95% CI 0.48 - 1.00；P = 0.047）。31%的病例发生了致命急性事件，主要原因是呼吸衰竭和大出血。
在死亡前30天内进行SACTs与更差的预后和更具侵袭性的疾病相关。在死亡前14天内给药时，大出血可能与治疗有关。这些发现强调了仔细选择患者和早期整合姑息治疗的必要性。
在线版本包含可在10.1007/s00432-025-06297-5获取的补充材料。
