Patterns of care analysis for head &amp; neck cancer of unknown primary site: a survey inside the German society of radiation oncology (DEGRO)

Grün, Jens Müller von der; Bon, Dimitra; Rödel, Claus; Balermpas, Panagiotis

doi:10.1007/s00066-018-1308-0

Cited by 14 publications

(11 citation statements)

References 30 publications

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“…5 Recently, an increasing trend in the epidemiology of SCCUP has been observed. 8 Mounting evidence has shown an increased prevalence of human papillomavirus (HPV)-related SCCUP, which seems to display a better prognosis than non-HPV-related SCCUP, and has a weaker association with tobacco and alcohol abuse. 8 Mounting evidence has shown an increased prevalence of human papillomavirus (HPV)-related SCCUP, which seems to display a better prognosis than non-HPV-related SCCUP, and has a weaker association with tobacco and alcohol abuse.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Due to the rarity of SCCUP, the available literature is limited to small retrospective studies using different diagnostic criteria and treatment strategies. 8 Mounting evidence has shown an increased prevalence of human papillomavirus (HPV)-related SCCUP, which seems to display a better prognosis than non-HPV-related SCCUP, and has a weaker association with tobacco and alcohol abuse. 9 The interest toward HPV-related SCCUP has been growing consequent to the refinements in diagnostic procedures and better understanding of the natural history of the disease.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2019

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“…After an intensive literature search in Pubmed and Medline we have only found one comparable survey about patterns of care for CUP. It has been performed recently in Germany, only included radiation oncologists and has revealed that 82% of the departments routinely determined HPV status in CUP (48). This rate is significantly higher than in Switzerland.…”

Section: Results and Discussion Of Biomarkers With Current Potential Usementioning

confidence: 99%

A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study—Part 4 (Biomarkers)

et al. 2019

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Background: The Head and Neck Cancer Working Group of Swiss Group for Clinical Cancer Research (SAKK) has investigated the level of consensus (LOC) and discrepancy in everyday practice of diagnosis and treatment in head and neck cancer.Materials and Methods: An online survey was iteratively generated with 10 Swiss university and teaching hospitals. LOC below 50% was defined as no agreement, while higher LOC were arbitrarily categorized as low (51–74%), moderate (75–84%), and high (≥85%).Results: Any LOC was achieved in 62% of topics (n = 60). High, moderate, and low LOC were found in 18, 20, and 23%, respectively. Regarding Head and Neck Surgery, Radiation Oncology, Medical Oncology, and biomarkers, LOC was achieved in 50, 57, 83, and 43%, respectively.Conclusions: Consensus on clinical topics is rather low for surgeons and radiation oncologists. The questions discussed might highlight discrepancies, stimulate standardization of practice, and prioritize topics for future clinical research.

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“…der transoralen Laser-Mikrochirurgie hingewiesen. Auf der Basis einer Umfrage unter den Strahlentherapeuten in Deutschland wird die 18 F-FDG-PET/CT zur Primärtumorsuche vorwiegend an universitären Einrichtungen eingesetzt [10].…”

Section: Pet/ct Bei Carcinoma Of Unknown Primary (Cup)unclassified

18F-FDG-PET/CT bei Kopf-Hals-Tumoren – Perspektiven für neue Behandlungsalgorithmen

2020

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Bei fortgeschrittenen Kopf-Hals-Tumoren sind der Organerhalt und die kurative Behandlung der Anspruch an moderne Therapiekonzepte. Sowohl im initialen Staging als auch im Therapiemonitoring ergeben sich für die metabolische Bildgebung mittels der 18 F-FDG-PET/CT Einsatzfelder: ▪ Therapieplanung (Ausschluss von Fernmetastasen, Ausschluss distanter Lymphknotenmetastasen, Strahlentherapieplanung analog Involved-field oder Involved-node, Planung der Level einer Neck-Dissection), ▪ ggf. frühes Therapiemonitoring (z. B. nach 1 Zyklus Induktionschemotherapie), ▪ Therapiekontrolle nach Abschluss der Radiochemotherapie (Frage, ob Salvage-Neck-Dissection notwendig), ▪ in der frühzeitigen Rezidiv-Diagnostik und ▪ bei der Suche nach einem Primärtumor in unbekannter Lokalisation (CUP-Syndrom). Vom Gemeinsamen Bundesausschuss konsentierte Indikationen Der Gemeinsame Bundesausschuss (G-BA) hat 2017 eine Vergütung der 18 F-FDG-PET/CT für folgende Indikationen verabschiedet [4]: ▪ Entscheidung über die Durchführung einer Neck-Dissection bei Patienten mit fortgeschrittenen Kopf-Hals-Tumoren oder mit unbekannten Primärtumorsyndromen des Kopf-Hals-Bereichs.

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Patterns of care analysis for head & neck cancer of unknown primary site: a survey inside the German society of radiation oncology (DEGRO)

Abstract: Diagnostics and treatment for SCCHN CUP within the DEGRO remain heterogeneous. A prospective register trial with standard operation procedures is warranted to homogenize and possibly improve management.

Cited by 14 publications

References 30 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

A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study—Part 4 (Biomarkers)

18F-FDG-PET/CT bei Kopf-Hals-Tumoren – Perspektiven für neue Behandlungsalgorithmen

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