Tailored multimodality therapy guided by a two-step decision making process for head-and-neck cancer of unknown primary

Abstract

BackgroundThere is no consensus on the treatment of head-and-neck cancer of unknown primary (HNCUP). The objective of this study is to report our single institution's experience of a tailored multimodality therapy guided by a two-step decision making process.Materials and MethodsFrom January 2007 to November 2013, 92 consecutive patients of HNCUP were treated. 77 patients were treated according the process above, 24 were treated by radiotherapy to the nasopharyngeal site, 7 received neck dissection and radiotherapy to other putative mucosal site, 30 were treated by neck dissection alone, and 16 received neck dissection followed by radiotherapy to the neck. SPSS 20.0 software was used for statistical analysis.ResultsAfter a median follow-up of 34 months, the 3-year overall survival rate was 84.5%. The 3-year mucosal control rate, neck control rate, distant metastasis-free survival rate and disease-free survival rate were 80.9%, 76.2%, and 92.0%, respectively. Of the 24 patients treated as putative nasopharyngeal carcinoma, no primary emerged from any site. Primary tumor emerged in 14 patients, and no primary emerged in the 31 patients treated with putative site radiation (3-year mucosal control rate: 100% vs. 67.9%, p = 0.010). Of the 46 patients treated with neck dissection with/without postoperative radiation, 14 developed neck recurrence, and patients without postoperative radiation suffered more ipsilateral neck recurrence.ConclusionsThe two-step decision-making process seem to be reasonable in treating Chinese HNCUP patients. However, this results need to be prospectively validated.

Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

“…We used a two-sided log-rank test to calculate the sample size. Because historical data showed a 3-year MRFS rate of 64.3% in HUCUP patients treated by ND ± neck radiation without radiation to the mucosa, 14 we assumed a 3-year MRFS rate of 90% in this study. To detect such a difference, a minimum of 43 patients (type I error 5% and power 90%) was required.…”

“…Putative NPC is treated by elective irradiation to the nasopharynx and bilateral neck. Non‐putative NPC is treated by upfront neck dissection (ND) followed by irradiation to the unilateral oropharynx, hypopharynx, and supraglottic structures and neck LN levels; sparing the nasopharynx, oral cavity, vocal cords, subglottic larynx, and cervical esophagus . Using this elective treatment approach, we anticipate encouraging mucosal control with acceptable toxicities, especially in late toxicities.…”

Head and neck squamous cell carcinoma of unknown primary - Who can be offered surgery as the sole treatment modality? A systematic review

“…A total of 14 studies have met the eligibility criteria and are presented herein. (50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63).…”

“…The characteristics of the studies included in this systematic review are summarised in table 1. The studies were published between 2002 and 2021 and originate from centres in the USA (51,53,55,57), Europe (50,52,56,64), Asia (58,59,(61)(62)(63) and Australia (54). There were no eligible studies from the UK.…”

Supervivencia de pacientes con metástasis cervical de primario desconocido en el Instituto Nacional de Oncología y Radiobiología. 2007-2012

“…Otros autores obtuvieron tasas de supervivencia superior como Shengjin y cols. 31 en China y Tiong y cols. 32 en Estados Unidos con 84,5% y 90% respectivamente.…”