Transoral endoscopic base of tongue mucosectomy for investigation of unknown primary cancers of head and neck

Wallis, Sebastian; O’Toole, L.; Karsai, Laszlo; Jose, Jemy

doi:10.1111/coa.13096

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…11,40,41 Blind biopsies from the nasopharynx, palatine tonsil, tongue base, and piriform sinus were commonly performed in the past, but is not currently standard practice in patients with radiological and clinical normal findings. [45][46][47][48][49][50] Unfortunately, the corresponding studies report on the identification rate of these techniques in the overall population of SCCUP and does not specify its efficacy in the subset of HPV-related SCCUP. 43 Bilateral tonsillectomy is controversial but identifies a primary tumor site in 15%-25% without major morbidity.…”

Section: Diagnostic Approachmentioning

confidence: 99%

“…42 Examination with microlaryngoscopy under general anesthesia with biopsy/excision of suspicious areas increases the primary tumor detection rate from 25% to 94%. [45][46][47][48][49][50] In one study of 64 patients with SCCUP (48 HPV-related SCCUP) undergoing lingual mucosectomy and tonsillectomy, the primary lesion is reported more frequently in the base of the tongue than in the palatine tonsil (86% vs 14%). 44 Transoral laser microsurgery or transoral robotic surgery has recently emerged as effective modalities in the identification and treatment of SCCUP.…”

Section: Diagnostic Approachmentioning

confidence: 99%

“…[45][46][47][48][49][50] Unfortunately, the corresponding studies report on the identification rate of these techniques in the overall population of SCCUP and does not specify its efficacy in the subset of HPV-related SCCUP. [45][46][47][48][49][50] In one study of 64 patients with SCCUP (48 HPV-related SCCUP) undergoing lingual mucosectomy and tonsillectomy, the primary lesion is reported more frequently in the base of the tongue than in the palatine tonsil (86% vs 14%). 46 Bilateral tongue base resection detects the primary tumor more often than unilateral resection (80% vs 68%).…”

Section: Diagnostic Approachmentioning

confidence: 99%

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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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Section: Diagnostic Approachmentioning

confidence: 99%

Section: Diagnostic Approachmentioning

confidence: 99%

Section: Diagnostic Approachmentioning

confidence: 99%

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

2019

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“…To address this bias, a propensity score analysis was performed ( supplementary data ). While tonsillectomy was the rule at the time of study, tongue-base biopsies and endoscopically-guided mucosectomies are increasingly used to maximize the chances of non-clinical primary diagnosis, suggesting that some HNCUP may indeed be small oropharyngeal primaries [ 36 , 37 ]. Similarly, HPV and Epstein–Barr virus (EBV) testing have been recommended as systematic in HNCUP only by the latest Union for International Cancer Control (UICC) TNM classification (8th TNM 2017) update.…”

Section: Discussionmentioning

confidence: 99%

Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary

Abu-Shama

Salleron

Carsuzaa

et al. 2021

Cancers

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Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.

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“…The transcanal approach is the least traumatic approach. 10 Based on our experience, the transcanal approach is more direct and quicker. We believe it results in less surgical trauma and postoperative discomfort for the patient and also reduces the likelihood of healing problems.…”

Section: Strengths Of the Studymentioning

confidence: 93%

Transcanal Approach for Type 2 Tympanoplasty with Incus Interposition Ossiculoplasty: Our Experience on 134 Patients

Aslan

Toker²,

Özgür

2018

Clinical Otolaryngology

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fines imposed) by investigating PET-CT findings, there is a need for such analysis in this time of austerity and increasing PET-CT use. | Future directions for PET-CTMehanna et al demonstrated that complete metabolic response on PET-CT with residual adenopathy had a high negative predictive value in human papillomavirus-associated oropharyngeal carcinoma. 3 Although these patients underwent protocol-driven neck dissection, the authors suggested imaging-based follow-up could be adopted in this subgroup. Whether this approach can be extrapolated to human papillomavirus-negative HNSCC with complete metabolic response and residual adenopathy is unknown. Data have been derived mainly from retrospective, smaller, non-randomised studies. 10 New research may spare a small number of additional patients a neck dissection. CONF LICTS OF INTERESTNone to declare.

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Transoral endoscopic base of tongue mucosectomy for investigation of unknown primary cancers of head and neck

Cited by 6 publications

References 11 publications

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

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

Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary

Transcanal Approach for Type 2 Tympanoplasty with Incus Interposition Ossiculoplasty: Our Experience on 134 Patients

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