Five-year outcomes of an oropharynx-directed treatment approach for unknown primary of the head and neck

Oral Oncol. 2017 Jul:70:14-22. doi: 10.1016/j.oraloncology.2017.05.001. Epub 2017 May 13.

Abstract

Purpose: Squamous cell carcinoma of unknown primary (SCCHNUP) is commonly treated with comprehensive radiation to the laryngopharynx and bilateral necks. In 1998, we established a departmental policy to treat SCCHNUP with radiation directed to the oropharynx and bilateral neck.

Methods: From 1998-2011, 60 patients were treated - N1: 18%, N2: 75% and N3: 7%. 82% underwent neck dissection. 55% received IMRT and 62% underwent concurrent chemoradiotherapy.

Results: At median follow-up of 54months, 5 patients failed regionally and 4 emerged with a primary (tongue base, hypopharynx and thoracic esophagus). Five-year rates of regional control, primary emergence, distant metastasis, disease-free survival and overall survival were 90%, 10%, 20%, 72% and 79%, respectively. The 5year rate of primary emergence in a non-oropharynx site was 3%.

Conclusion: This is the first demonstration that an oropharynx-directed approach yields low rates of primary emergence in SCCHNUP with excellent oncologic outcomes.

Keywords: Emergence; Oropharynx; Radiation; Unknown primary.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / radiotherapy*
  • Carcinoma, Squamous Cell / surgery*
  • Combined Modality Therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Neoplasms, Unknown Primary / diagnostic imaging
  • Neoplasms, Unknown Primary / radiotherapy*
  • Neoplasms, Unknown Primary / surgery*
  • Oropharyngeal Neoplasms / diagnostic imaging
  • Oropharyngeal Neoplasms / radiotherapy*
  • Oropharyngeal Neoplasms / surgery*
  • Positron-Emission Tomography
  • Radiotherapy, Intensity-Modulated
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult