Management of unilateral head and neck carcinoma of unknown primary: Retrospective analysis of the impact of postoperative radiotherapy target volumes

Abstract

Background: We compared the outcome of postoperative unilateral cervical nodes radiotherapy (UL-RT) vs bilateral cervical nodes plus total mucosal irradiation (COMP-RT) in the management of head and neck carcinoma of unknown primary (HNCUP).Methods: HNCUP, defined by the absence of primary despite a PET-CT combined with a panendoscopy, were treated with curative intent by initial ipsilateral neck dissection. Sixty-nine patients with unilateral HNCUP were included: 23 received UL-RT while 46 received COMP-RT. Carcinologic outcomes and long-term quality of life (QOL) according to the QOL Questionnaire for Head and Neck 35 were assessed. Results: Within 6.3 years of median follow-up, there was no significant difference in primary tumor emergence rate (P = .68), cervical node recurrence rate (P = .34), or overall survival (P = .33) between UL-RT and COMP-RT groups.A trend toward QOL improvement was observed in the UL-RT group. Conclusion: UL-RT seems to provide similar outcomes as COMP-RT in unilateral HNCUP management. K E Y W O R D Scarcinoma unknown primary, head and neck, postoperative radiotherapy, quality of life

Is bilateral radiotherapy necessary for patients with unilateral squamous cell carcinoma of unknown primary of the head and neck region?

“…We found that local recurrences occurred in all cases on the initially affected side of the neck, and in 85 % in the former CTV. This is comparable to other studies showing none [31] , [32] , [33] , [34] , [35] or only a single [10] , [27] , [36] contralateral recurrence among the unilaterally irradiated patients. Some older cohorts form the 2D era describe higher rates of contralateral recurrences from 10 % up to 15.6 % [8] , [26] , [37] .…”

Radiotherapy to the neck after neck dissection for head and neck squamous cell carcinoma from an unknown primary: A narrative review

“…In a French study published in 2020, Podeur et al, 13 compared the outcomes of post‐operative unilateral cervical nodal radiotherapy ( n = 23) against post‐operative bilateral cervical nodal plus total mucosal radiation ( n = 44). All patients underwent neck dissection.…”

“…Podeur et al 13 also provided information on acute and late toxicity and QOL measures in patients treated with unilateral or bilateral post‐operative neck radiotherapy. The incidences of grade ≥2 radiation dermatitis were similar (48% vs. 46%, p = 1.00) but there was greater grade ≥2 mucositis (44% vs. 59%, p = .31) and weight loss >4 kg (26% vs. 48%, p = .12) in patients treated with bilateral radiotherapy; however, this difference was not significant.…”