Patterns of Failure in Patients With Head-and-Neck Carcinoma of Unknown Primary Treated With Radiation Therapy

Unknown primary head and neck squamous cell carcinoma in the era of fluorodeoxyglucose‐positron emission tomography/CT and intensity‐modulated radiotherapy

“…This overview does not include all articles about IMRT in head and neck CUP, because we only selected the articles with more than 25 patients treated with IMRT. Comparing 2D/3D 15,[20][21][22][23][24] to the other IMRT articles, 13,14,25,26 it seems as if the OS in the IMRT cohort is slightly better (mean 5-year OS of 73% vs 91%) with improved neck control (mean 44% vs 75%). Explanations for these differences are the more frequent use of concomitant chemotherapy in the IMRT era and also the improved pretreatment staging with PET-CT. Our results are fairly comparable with the studies included in the review in Table 2.…”

“…In head and neck CUP, the use of induction chemotherapy is not studied prospectively, but only in several retrospective series. [13][14][15] For the high-risk patients (N3 disease, low neck nodes, and massive ECE) it may be interesting to explore the role for TPF induction chemotherapy.…”

“…To make our analyses clinically applicable to date, we chose to include only patients who have had a workup with all the modern imaging techniques (at least 2 modalities of PET/MRI/CT) and who have been treated with IMRT or VMAT. In Table 4, [13][14][15][20][21][22][23][24][25][26] an overview of the literature is shown divided by radiation technique (2D/3D vs IMRT). This overview does not include all articles about IMRT in head and neck CUP, because we only selected the articles with more than 25 patients treated with IMRT.…”

A Nordic survey on the management of head and neck CUP

“…Furthermore, they found that patients with N2b-N3 disease, with a significantly lower survival rate (66.7%, p ¼ 0.017), benefitted from concurrent chemotherapy, targeted therapeutic agents or accelerated radiotherapy regimens, in addition to surgery. Cuaron et al [17], however, found that conventional radiotherapy produced excellent locoregional control of HNCUP with acceptably low levels of late toxicity. Chen et al [18] reported that concurrent chemoradiotherapy was associated with significantly increased toxicity without definite benefit in overall survival or locoregional control in the treatment of HNCUP.…”

Pharyngeal‐sparing radiation for head and neck carcinoma of unknown primary following TORS assisted work‐up

“…[5][6][7] While such treatment is associated with low rates of local and regional failure, treatmentrelated morbidity is substantial. 8,9 Currently, the majority of patients diagnosed with HNCUP have HPV-associated disease. 10 Given the more favorable prognosis of HPVassociated oropharyngeal carcinomas as well as the substantial morbidity of historic treatment, de-intensification strategies for HNCUP have been proposed.…”