Neck dissection for unknown cancer of the head and neck in the era of chemoradiation

Amsbaugh, Mark J.; Gaskins, Jeremy; Silverman, Craig L.; Potts, Kevin; Bumpous, Jeffrey M.; Redman, Rebecca; Perez, Cesar A.

doi:10.1016/j.amjoto.2017.06.006

Cited by 20 publications

(20 citation statements)

References 25 publications

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“…Overall, the locoregional relapse rate did not statistically differ between unilateral neck irradiation (17%) and comprehensive radiotherapy (28%). These results are comparable to those of recent studies with neck relapse rate ranging from 6% to 22% after unilateral radiotherapy and 0% to 31% after comprehensive radiotherapy …”

Section: Discussionsupporting

confidence: 90%

“…Salvage therapy consisted in radiotherapy (two patients), surgery (two patients), surgery plus postoperative radiotherapy (two patients), chemotherapy or targeted therapy with palliative intent ( four patients). All patients died of their disease within a median time of 9.8 months after salvage therapy, eight due to distant metastases and two due to local evolution and fatal carotid hemorrhage. The regional control rate was 83% in the UL‐RT group and 72% in the COMP RT ( P = .39).…”

Section: Resultsmentioning

confidence: 99%

“…Many different treatment modalities, based on retrospective studies, have been suggested to treat this rare head and neck tumor. Currently, neck dissection followed by postoperative radiotherapy seems to be the most consensual approach . Nevertheless, the extent of radiotherapy target volume remains a controversial topic in consideration of whether a hypothetic primary tumor should be treated or not.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…46 Transoral microscopic resection has been assessed in seven patients with HPV-related SCCUP who underwent ipsilateral selective neck dissection of levels II through IV. 76 The role of neck dissection in HPV-related SCCUP was evaluated in one case series of 41 patients treated with neck dissection (radical, modified, or selective) followed by adjuvant RT or primary CRT. Both 5-year disease-free survival (DFS) and OS were 100%.…”

Section: Surgical Diagnostic Procedures and Neck Dissectionmentioning

confidence: 99%

“…Actually, one case series of 66 patients with SCCUP including all lymph node stages, 29 treated with nonoperative therapy, and 37 treated with neck dissection followed by adjuvant treatment showed that neck dissection achieved higher local control (local recurrence free survival 96.6% vs 54.1%; P = .003) without OS benefit (3-year OS 63.9% vs 59.8%; P = .64). 76 The role of neck dissection in HPV-related SCCUP was evaluated in one case series of 41 patients treated with neck dissection (radical, modified, or selective) followed by adjuvant RT or primary CRT. 24 Outcome analysis demonstrated similar 2-, 5-, and 10-year OS (93%, 89%, and 89% vs 90%, 90%, and 80% in the two groups, respectively).…”

Section: Surgical Diagnostic Procedures and Neck Dissectionmentioning

confidence: 99%

Comprehensive management of HPV‐related squamous cell carcinoma of the head and neck of unknown primary

2019

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Background Human papillomavirus (HPV)‐related squamous cell carcinoma of unknown primary (SCCUP) is currently rising in incidence but lacks a validated management approach. Aims This paper reviews the clinical presentation, diagnosis, and treatment of HPV‐related SCCUP. Materials and Methods The Medline/Pubmed database was searched by using the following keywords “CUP”, “cancer of unknown primary”, “HPV”, “human papilloma virus”, and “head and neck”. The references of the publications of interest were also screened for relevant papers. Results The clinical assessment of HPV‐related SCCUP includes a complete clinical examination, an endoscopic evaluation with white‐light and narrow band imaging, and radiologic assessment using morphologic and metabolic imaging. If the diagnosis remains unconfirmed, endoscopic examination under anesthesia with tonsillectomy ± base of tongue mucosectomy is performed. The therapeutic rationale aims to eradicate the involved lymph nodes and potential primary tumor with a sequence of chemoradiotherapy and neck dissection. Discussion As a general approach, p16‐negative SCCUP are truly HPV negative, whereas p16‐positive specimens require confirmation with HPV in situ hybridization or polymerase chain reaction to confirm HPV infection. If a cervical metastasis is considered HPV positive, the primary lesion is likely in the oropharynx, and further diagnostic interventions such as tonsillectomy seems to be mandatory. Whether the optimal treatment is neck dissection followed by adjuvant radiotherapy or concomitant chemoradiotherapy (CRT) (in case of extranodal extension or advanced lymph node stages) or definitive CRT followed by neck dissection (in case of positive 18F‐FDG‐PET/CT) remains a matter of debate. Solid scientific evidence supporting treatment de‐escalation in HPV‐related SCCUP is lacking, and the results of ongoing trials are at the brink of reporting. Conclusion Currently, the treatment of patients with HPV‐related SCCUP should not differ from the standard treatment of other SCCUP patients and is similarly based on the staging of the disease and general condition of the patient.

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

Dou

Zhang

et al. 2020

Cancer Medicine

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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.

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Neck dissection for unknown cancer of the head and neck in the era of chemoradiation

Cited by 20 publications

References 25 publications

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

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

Comprehensive management of HPV‐related squamous cell carcinoma of the head and neck of unknown primary

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

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