A Nordic survey on the management of head and neck CUP

Farnebo, Lovisa; Laurell, Göran; Mäkitie, Antti

doi:10.1080/00016489.2016.1193894

Cited by 11 publications

(18 citation statements)

References 18 publications

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“…This distribution is similar to that found in 2016 by Farnebo et al studying the management of patients with SCC-CUP in 22 main centers in five Nordic countries (Iceland, Norway, Sweden, Finland, and Denmark). Routine bilateral tonsillectomy was performed in about 80% of cases compared to 20% for unilateral tonsillectomy (6).…”

Section: Benefits Of Tonsillectomymentioning

confidence: 99%

Role of Tonsillectomy in the Management of Carcinomas of Unknown Primary of the Head and Neck: A Retrospective Study Based on p16 Analysis

et al. 2020

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Purpose: To evaluate the impact of tonsillectomy on the detection of the primary tumor, based on p16 immunohistochemistry analysis, in patients with cervical unknown primary of squamous cell carcinoma (SCC-CUP). Methods: This was a retrospective study of 63 patients, included from January 2008 to December 2017 in a single institution. All patients had an initial assessment with physical examination, CT scan of the neck and chest, whole body FDG-PET CT, and endoscopy under general anesthesia, which failed to determine the primary tumor. Results: Forty-seven out of the 63 patients had an ipsi-or bilateral tonsillectomy which revealed 12 tonsil cancers (26%). The tonsil primary was ipsilateral to positive nodes in 10 cases, contralateral in 1 case and, in 1 case, the patient had bilateral neck involvement. The analysis of the p16 status was carried out in 41/63 patients (65%). Among the 32 patients who had a p16 analysis and tonsillectomy, the rate of primary detection was 59% (10/17) for p16-postives and 0% (0/15) for p16-negatives (p < 0.001). Conclusion: These results suggest that an extended work-up should be systematically proposed including bilateral tonsillectomy (+/-mucosectomy of the base of tongue) in SCC-CUP p16-positive patients but not in p16-negatives.

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Section: Benefits Of Tonsillectomymentioning

confidence: 99%

Role of Tonsillectomy in the Management of Carcinomas of Unknown Primary of the Head and Neck: A Retrospective Study Based on p16 Analysis

et al. 2020

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“…16,18,22 Tobacco use (pack-year ≤10 or >10) and lymph node involvement (N1-N2b or N2c-N3) were not found to have an impact on the prognosis in HPV/p16-positive SCCUP. 70 In the absence of prospective data for HPV-related SCCUP, the current guidelines lack level I evidence recommendations.…”

Section: Treatment Of Hpv-related Sccupmentioning

confidence: 99%

“…To date, therapeutic options include neck dissection alone, RT or CRT followed by neck dissection in case of 18 F-FDG-PET/CT positivity in the neck, and a combination of neck dissection with RT or CRT. 70…”

Section: Treatment Of Hpv-related Sccupmentioning

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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“…and multiple other details we have discussed are all recommended at different frequencies by different groups, even sometimes within the same geographic region (125).…”

Section: Discussionmentioning

confidence: 99%

Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era

et al. 2020

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A Nordic survey on the management of head and neck CUP

Cited by 11 publications

References 18 publications

Role of Tonsillectomy in the Management of Carcinomas of Unknown Primary of the Head and Neck: A Retrospective Study Based on p16 Analysis

Role of Tonsillectomy in the Management of Carcinomas of Unknown Primary of the Head and Neck: A Retrospective Study Based on p16 Analysis

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

Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era

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