Carcinoma of Unknown Primary and the 8th Edition <scp>TNM</scp> Classification for Head and Neck Cancer

Boeker, Robert; Stromberger, Carmen; Heiland, Max; Beck‐Broichsitter, Benedicta; Hofmann, Veit Maria; Neumann, Konrad; Ochsenreither, Sebastian; Dommerich, Steffen; Piwonski, Iris; Coordes, Annekatrin

doi:10.1002/lary.29499

Cited by 9 publications

(5 citation statements)

References 41 publications

(105 reference statements)

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“…In a retrospective study, Sivars et al showed a significantly better 5-year OS for HPV-positive CUPs in comparison to HPV-negative CUPs (80% vs. 36.7%, p = 0.004) [ 37 ]. Axelsson et al confirmed these results in the review of the Swedish Cancer Registry with a total of 68 patients, which are also consistent with the analysis of Cheraghlou et al of the National Cancer Database of the United states with a total of 978 patients [ 8 , 38 , 39 ]. In our cohort, we were not able to demonstrate any advantage in the multiple analysis either for HPV-positive or -negative HNCUPs.…”

Section: Discussionsupporting

confidence: 75%

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Rupp

Mantsopoulos

Sievert

et al. 2022

JCM

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Background: This study on patients with head and neck cancer of unknown primary (HNCUP) assesses the impact of surgical and non-surgical treatment modalities and the tumour biology on the oncological outcome. Methods: A total of 80 patients with HNCUP (UICC I–IV) were treated with simultaneous neck dissection followed by adjuvant therapy, between 1 January 2007 and 31 March 2020. As the primary objective, the influence of treatment modalities on the overall survival (OS), the disease-specific survival (DSS) and the progression-free survival (PFS) were analysed in terms of cox regression and recursive partitioning. The tumour biology served as secondary objectives. Results: The 5-year OS for the entire cohort was 67.7%, (95% CI: 54.2–81.2%), the 5-year DSS was 82.3% (72.1–92.5%) and the 5-year PFS was 72.8% (61.8–83.8%). Cox regression revealed that patients undergoing adjuvant radiotherapy only had a four times higher risk to die compared to patients receiving chemoradiation therapy (HR = 4.45 (1.40; 14.17), p = 0.012). The development of distant metastases had a significantly negative impact on OS (HR = 8.24 (3.21–21.15), p < 0.001) and DSS (HR = 23.79 (6.32–89.56), p < 0.001). Recursive portioning underlined the negative influence of distant metastases on OS (3.2-fold increase in death probability) and DSS (4.3-fold increase in death probability), while an UICC stage of IVb increased the risk for further progression of the disease by a factor of 2. Conclusions: The presence of distant metastases as well as adjuvant treatment with radiation without concomitant chemotherapy, were among others, significant predictors for the overall survival of HNCUP patients, with distant metastases being the most significant predictor.

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Section: Discussionsupporting

confidence: 75%

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Rupp

Mantsopoulos

Sievert

et al. 2022

JCM

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show abstract

“…In a retrospective study, Sivars et al showed a significantly better 5-year OS for HPV-positive CUPs in comparison to HPV-negative CUPs (80% vs. 36.7%, p = 0.004) [37]. Axelsson et al confirmed these results in the review of the Swedish Cancer Registry with a total of 68 patients, which are also consistent with the analysis of Cheraghlou et al of the National Cancer Database of the United states with a total of 978 patients [8,38,39]. In our cohort, we were not able to demonstrate any advantage in the multiple analysis either for HPV-positive or -negative HNCUPs.…”

Section: Discussionsupporting

confidence: 65%

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Balk

Rupp

Mantsopoulos

et al. 2023

94th Annual Meeting German Society of Oto-Rhino-Laryngology, Head and Neck Surgery e.V., Bonn

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“…Alterations of the tumor staging from UICC7 to UICC8 included mainly UICC stage III or IVa according to the 7 th edition. Our patient remained at the same stage UICC IVc, and had in both tumor, node and metastasis (TNM) classifications the lowest OS (OS UICC IVc TNM7 12 mo; OS UICC IVc TNM8 5 mo[ 16 ]). But regardless of p16 status, the addition of cetuximab to radiation therapy improved patient outcome.…”

Section: Discussionmentioning

confidence: 99%

Long-term survivor of metastatic squamous-cell head and neck carcinoma with occult primary after cetuximab-based chemotherapy: A case report

Große-Thie¹,

Maletzki²,

Junghanß³

et al. 2021

WJCC

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BACKGROUND Cancer of unknown primary (CUP) is a histological proven malignant tumor whose origin cannot be detected despite careful examination. Most cervical lymph node metastases in CUP (80%) will originate from head and neck sites, and 15% show infiltration of squamous carcinoma cells. The survival rates of CUP are poor: The 5-year-survival rate ranges from 10% to 15%. First-line treatment recommendation for advanced, inoperable squamous cell carcinoma of head/neck (HNSCC) was cetuximab plus platinum-fluorouracil chemotherapy until recently, when checkpoint inhibitors proved clinically beneficial therapies. CASE SUMMARY Here, we report a case of a 42-year-old female patient with cervical and abdominal lymph node and distant bone metastases of an occult primary of the head and neck (squamous cell carcinoma, human papillomavirus positive). The cancer was diagnosed during pregnancy 10 years ago, and after giving birth, the patient was treated with cetuximab plus platinum-fluorouracil chemotherapy achieving complete remission (CR). CR lasted 26 mo when new metastases (abdominal lymph node, lumbar vertebral body) emerged. Both manifestations were irradiated. From then on, the patient has not received any further treatment, and her disease has remained controlled. Ten years after the initial cancer diagnosis, the patient is still alive and in good health, representing an exceptional case of HNSCC. CONCLUSION This case illustrates the exceptional clinical course and benefits of combined therapy approaches in advanced metastatic HNSCC with occult primary.

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Carcinoma of Unknown Primary and the 8th Edition TNM Classification for Head and Neck Cancer

Cited by 9 publications

References 41 publications

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP)

Long-term survivor of metastatic squamous-cell head and neck carcinoma with occult primary after cetuximab-based chemotherapy: A case report

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