Benefit of postoperative chemoradiotherapy for patients with unknown primary squamous cell carcinoma of the head and neck

Shehadeh, N. J.; Ensley, John F.; Küçük, Ömer; Black, Correy; Yoo, George H.; Jacobs, John R.; Lin, Ho Sheng; Heilbrun, Lance K.; Smith, Daryn; Kim, Harold

doi:10.1002/hed.20470

Cited by 36 publications

(29 citation statements)

References 47 publications

(46 reference statements)

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“…However there are no randomised studies for patients with cervical CUPs and the rationale of treatment is based on the results of primary known cancer of the head and neck and small series of patients with SCC of unknown primary [34,41,42]. In the recent report by Shehadeh et al [42], 37 patients were managed with neck dissection followed by concurrent high-dose cisplatin and irradiation of bilateral neck/mucosal sites. At a median follow-up of 42 months, 89% of the patients were alive.…”

Section: Answers To the Questions Proposedmentioning

confidence: 97%

Unknown primary cancer of the head and neck: a multidisciplinary approach

2011

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The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.

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Section: Answers To the Questions Proposedmentioning

confidence: 97%

Unknown primary cancer of the head and neck: a multidisciplinary approach

2011

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“…The optimal method of radiotherapy for NUP had been controversial for a long time, as it is difficult to conduct randomized or prospective studies of this rare disease (18). Some case studies have revealed therapeutic outcomes of NUP treated by radiotherapy combined with surgery and/or chemotherapy, which are summarized in Table 5 (3,6,9,11,16,17,(19)(20)(21). Prognostic factors for survival are reported to be nodal stages, number of positive nodes, neck dissection, histopathological grading and ECE (3)(4)(5)7,9,19,20,22,23).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

Yamazaki

Kodaira

Ota

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: To investigate the optimal treatment method and risk factor of neck node metastasis from unknown primary tumors (NUP) treated by radiotherapy. Methods: Retrospective case study based on a multi-institutional survey was conducted by the Japanese Radiation Oncology Study Group. Patients pathologically diagnosed as having NUP from 1998 to 2007 were identified. Univariate and multivariate analyses of overall survival (OS), progression free survival (PFS), neck progression free survival (NPFS) and mucosal progression free survival (MPFS) were evaluated. Results: In total, 130 patients with median age of 65 years were included. Nodal stages N1, N2a, N2b and N2c were observed for 10, 26, 43, 12 and 39 patients, respectively. All the patients received radiotherapy (RT) with neck dissection in 60 and with chemotherapy in 67 cases. The median doses to the metastatic nodes, prophylactic neck and prophylactic mucosal sites were 60.0, 50.4 and 50.4 Gy, respectively. The median follow-up period for surviving patients was 42 months. Among 12 patients, occult primary tumors in the neck region developed after radiotherapy. The 5-year OS, PFS, NPFS and MPFS were 58.1%, 42.4%, 47.3% and 54.9%, respectively. Univariate analysis showed that lower N stage (N1-2b), non-bulky node (<6 cm) and negative extracapsular extension (ECE) status were the factors associated with favorable OS, PFS, NPFS and MPFS. Radical surgery proved to be a favorable factor of OS, NPFS and MPFS. On multivariate analysis, lower N stage and negative ECE status were correlated with improved survival.

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“…In the most recent retrospective report by Shehadeh et al, 37 patients with SQCCUP were managed with neck dissection followed by concurrent high-dose cisplatin and bilateral neck/mucosal sites irradiation [52]. A total dose of 64 Gy was administered in the involved side of the neck and 50 Gy to uninvolved neck and mucosal sites.…”

Section: Combined Modality Approachesmentioning

confidence: 99%

“…To the best of our knowledge there are only 4 retrospective studies with approximately 100 patients treated with various cytotoxic drugs (platinum or non-platinum). Chemotherapy was administered before, during or after radiotherapy and results in some studies were compared with historical controls [30,[50][51][52].…”

Section: Combined Modality Approachesmentioning

confidence: 99%

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary site: a favourable prognosis subset of patients with CUP

2009

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Squamous cervical cancer of unknown primary site (SQCCUP) presents in patients as neck lymph nodes involved by squamous carcinoma in the absence of identifiable primary in the head, neck or lung. This CUP subset affects male patients previously exposed to alcohol and tobacco, though a proportion of cases may be related to chronic infection of the oropharynx by human papilloma virus. A standardised diagnostic work-up consisting of panendoscopy of the upper aerodigestive tract, CT of the chest/abdomen and histology supplemented by immunohistochemistry is warranted for the diagnosis. The scant available evidence on the molecular biology of the disease is reviewed. The cornerstones of management are excisional biopsy or surgical extirpation of the disease followed by bilateral neck external beam radiotherapy and chemotherapy. The necessity for complete surgical resection of involved neck nodes, irradiation of all head/neck mucosal sites and administration of concurrent chemotherapy is currently being debated. Aggressive multimodal therapy results in longterm disease control in 50-60% of patients, though data are mainly based on retrospective cohorts. Factors predicting for superior patient outcome are radical management with surgery or radiotherapy, low stage and volume of disease, absence of extracapsular spread and good performance status. Recently introduced molecular profiling platforms may provide biological classification to a primary tissue of origin as well as insights into the pathophysiology of this clinical entity.

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Benefit of postoperative chemoradiotherapy for patients with unknown primary squamous cell carcinoma of the head and neck

Abstract: Postoperative chemoradiotherapy is of potential benefit to patients with unknown primary SCCHN by improving survival and reducing failures. This treatment warrants further prospective evaluation.

Cited by 36 publications

References 47 publications

Unknown primary cancer of the head and neck: a multidisciplinary approach

Unknown primary cancer of the head and neck: a multidisciplinary approach

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

Cervical lymph node metastases of squamous cell carcinoma from an unknown primary site: a favourable prognosis subset of patients with CUP

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