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

Abstract

Objective Controversy still exists regarding the volume of radiation for head and neck cancer of unknown primary (HNCUP). Theoretically, elective mucosal irradiation (EMI) should achieve a balance between survival and toxicity. This prospective study was conducted to evaluate the long‐term benefit of EMI in Chinese HNCUP patients. Methods A phase II, single‐arm trial was performed at two centers in China. HNCUP patients with pathologically confirmed metastatic squamous cell carcinoma or poorly differentiated carcinoma were enrolled. Patients with metastatic lymph nodes limited to level IV and/or the supraclavicular fossa were excluded. The EMI approach was specifically customized to Chinese patients by differentiating HNCUP as putative nasopharyngeal carcinoma (NPC) or non‐putative NPC. The primary endpoint was 3‐year mucosal recurrence‐free survival (MRFS). Results A total of 48 patients were enrolled between 02/02/2010 and 08/01/2018; 46 patients were analyzed, including 24 putative NPC and 22 non‐putative NPC patients. No primary recurrence was observed during a median follow‐up period of 70 months, and only 1 patient experienced out of field recurrence in the contralateral neck. The 3‐year MRFS was 90.6% (95%CI: 76.4%‐96.4%). The 5‐year MRFS, regional‐recurrence free survival (RRFS) and overall survival (OS) were 90.6% (95%CI: 76.4%‐96.4%), 86.0% (95%CI: 71.1%‐93.7%), and 90.6% (95%CI: 76.4%‐96.4%), respectively. No grade 4 acute or late toxicities occurred, and the most frequent grade 3 acute toxicity was oral mucositis (45.7%). Conclusion To the best of our knowledge, this is the first prospective study to evaluate the long‐term outcomes of EMI in Chinese HNCUP patients. Excellent MRFS and OS rates were observed. Further randomized studies are warranted.

Head and Neck Cancer of Unknown Primary: A Multicenter Retrospective Cohort study in Northern Thailand, an Endemic Nasopharyngeal Cancer Area

“…Our results revealed a neck recurrence rate of 27.1% which was in the same range as studies from endemic NPC countries reporting a rate of 10-42% [ 27 , 29 , 25 , 18 , 24 ]. In contrast, studies from non-endemic NPC countries reported a lower rate of 9-25% [ 10 , 31 , 32 ].…”

“…Treatment recommendation is, therefore, usually based on results from retrospective studies and institutional preference. Surgery or radiotherapy alone is considered for early nodal stages of the disease, and a combination of surgery followed by adjuvant (chemo)radiotherapy or primary chemoradiotherapy with or without surgery is required for more advanced disease [ 18 ].…”

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

“…Recent studies have tried to reduce patient side effects by reducing treatment intensity 35–38 . Ultimately, the search for the primary remains the patients' best chance of being assessed and referred to an appropriate therapy with multiple studies emerging in this field over recent years 39–42 . Karni et al have shown that transoral laser microsurgery reveals the primary oropharyngeal carcinoma in 94% of patients (37% palatine tonsil, 63% tongue‐base) 43 …”

“…[35][36][37][38] Ultimately, the search for the primary remains the patients' best chance of being assessed and referred to an appropriate therapy with multiple studies emerging in this field over recent years. [39][40][41][42] Karni et al have shown that transoral laser microsurgery reveals the primary oropharyngeal carcinoma in 94% of patients (37% palatine tonsil, 63% tongue-base). 43 This study's limitations are clearly associated with its retrospective approach.…”

Primario desconocido de cabeza y cuello, una visión del oncólogo radioterapeuta

“…No se produjo toxicidad aguda o tardía de grado 4. La toxicidad aguda de grado 3 más frecuente fue la mucositis oral (45.7%), xerostomía y disfagia de grado 3 en 2 (4.3%) y 4 pacientes (8.7%), respectivamente [25].…”