Intensity-Modulated Radiotherapy for Cervical Node Squamous Cell Carcinoma Metastases From Unknown Head-and-Neck Primary Site: M. D. Anderson Cancer Center Outcomes and Patterns of Failure

Frank, Steven J.; Rosenthal, David I.; Petsuksiri, Janjira; Ang, K. Kian; Morrison, William H.; Weber, Randal S.; Glisson, Bonnie S.; Chao, K.S. Clifford; Schwartz, David L.; Chronowski, Gregory M.; El‐Naggar, Adel K.; Garden, Adam S.

doi:10.1016/j.ijrobp.2009.09.006

Cited by 79 publications

(72 citation statements)

References 24 publications

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“…They concluded that patients with N1 disease without ECE could be managed by surgery alone, while patients with N2 or higher nodal stage disease, and/or ECE would be candidates for postoperative adjuvant radiation therapy. Although IMRT was not administered in this series, it is considered to be a promising procedure in treatment for NUP by offering appropriate target volume coverage while sparing organs-at-risk compared with conventional radiotherapy (11)(12)(13)15,21,28,29). Villeneuve et al reported promising results of NUP using the IMRT technique (11).…”

Section: Discussionmentioning

confidence: 89%

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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Section: Discussionmentioning

confidence: 89%

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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“…Emergence of a primary mucosal tumor in the hypopharynx and larynx has been reported to be occur less frequently than in the nasopharynx and oropharynx, leading some to suggest that these sites may be safely excluded from the extended RT fields to reduce treatment toxicity in selected patients with HNCUP (21, 24) . This consideration is especially relevant to non-smokers and patients with HPV-positive nodal metastases, in whom the primary tumor is highly likely to be oropharyngeal (25-27) .…”

Section: Discussionmentioning

confidence: 99%

Head and neck squamous cell carcinoma of unknown primary: Neck dissection and radiotherapy or definitive radiotherapy

et al. 2013

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Background Management of head and neck carcinoma from unknown primary (HNCUP) remains controversial, with neck dissection and radiotherapy (ND+RT) or definitive RT both commonly used. We aimed to characterize HNCUP and retrospectively compare outcomes for patients treated with ND+RT versus definitive RT. Methods From 1994-2009, 41 HNCUP patients underwent either ND+RT (n=22) or definitive RT+ concurrent chemotherapy (n=19) at our institution. Treatment outcomes were compared using Kaplan-Meier methods and log-rank test. Results There were no differences between patients treated with ND+RT and definitive RT in overall survival (OS), progression-free survival (PFS), or locoregional-relapse-free survival, freedom-from-locoregional failure, or freedom-from-distant failure. Among 17 ND+RT patients for whom human papillomavirus (HPV) status could be determined, HPV(+) patients trended towards improved OS (p=0.06)and PFS (p=0.15). Conclusions Neck dissection and post-op RT resulted in similar outcome as definitive RT. The prognostic implications of HPV(+) nodes in HNCUP are similar to those in oropharyngeal primary cancers.

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“…Previously, HNSCC/HNCUP was treated using a three-field technique including all mucosal sites and both sites of the neck [94], whereas today’s standard is intensity- IMRT preserving salivatory tissues [95]. The vast majority of the data presented here (Table 2) have been generated with older, non-conformal techniques.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

et al. 2017

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Background and PurposeThis review aims to provide a comprehensive overview of the literature and elucidate open questions for future clinical trials concerning diagnostics and treatment modalities for cervical cancer of unknown primary (CUP).MethodsA literature search for head and neck CUP was performed with focus on diagnostics and therapies as well as molecular markers.ResultsHigh level evidence on CUP is limited. However, it seems that a consensus exists regarding the optimal diagnostic procedures. The correct implementation of biomarkers for patient stratification and treatment remains unclear. An even greater dispute dominates about the ideal treatment with publications ranging from sole surgery to surgery with postoperative bilateral radiotherapy with inclusion of the mucosa and concomitant chemotherapy.ConclusionsCervical CUP represents a very heterogeneous malignant disease. On this account many aspects concerning treatment optimization remain unclear, despite a considerable number of publications in the past. Future research in form of prospective randomized trials is needed in order to better define patient stratification criteria and enable tailored treatment.

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Intensity-Modulated Radiotherapy for Cervical Node Squamous Cell Carcinoma Metastases From Unknown Head-and-Neck Primary Site: M. D. Anderson Cancer Center Outcomes and Patterns of Failure

Cited by 79 publications

References 24 publications

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

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

Head and neck squamous cell carcinoma of unknown primary: Neck dissection and radiotherapy or definitive radiotherapy

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

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