Radiotherapeutic Management of Cervical Lymph Node Metastases From an Unknown Primary Site

Perkins, Stephanie M.; Spencer, Chris; Chernock, Rebecca D.; Haughey, Bruce H.; Nussenbaum, Brian; Adkins, Douglas R.; Kuperman, D. I.; Thorstad, Wade L.

doi:10.1001/archoto.2012.1110

Cited by 62 publications

(77 citation statements)

References 21 publications

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“…Although HPV status was strongly associated with non-keratinizing tumor histology, as in other studies, it was not associated with year of diagnosis, cystic node presentation, tumor differentiation, or smoking status, in contrast to previous reports (25, 27, 34) . HPV expression was also associated with a non-significant trend toward improved PFS (p=0.15) and OS (p=0.06), analogous to those for HPV-positive squamous cell carcinoma of known oropharyngeal origin (11, 26, 30, 34, 35) .…”

Section: Discussionmentioning

confidence: 87%

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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Section: Discussionmentioning

confidence: 87%

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

et al. 2013

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“…Therefore some recommend removing the larynx and hypoharynx from the field. In addition, it has been shown that patients with CUP treated with ipsilateral radiotherapy compared to a more comprehensive radiotherapy did not demonstrate a worse locoregional control or overall survival [34]. The best radiotherapy plan for patients with CUP is however not universally agreed upon [35].…”

Section: Discussionmentioning

confidence: 99%

Human Papillomavirus in Head and Neck Squamous Cell Carcinoma of Unknown Primary Is a Common Event and a Strong Predictor of Survival

et al. 2014

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BackgroundThe purpose of this study was to examine the prevalence of human papillomavirus (HPV) in patients with head and neck squamous cell carcinoma of unknown primary (CUP).MethodsAll patients diagnosed with and treated for CUP between January 1, 2000, and June 1, 2011, at two Danish medical centers were included. All patients received a thorough diagnostic work-up, including FDG-PET, before being diagnosed as CUP. We determined the HPV status in all patients using a combination of HPV DNA PCR and p16 stain. In addition, clinical information on the study patients was retrieved from clinical records.ResultsOf the identified 60 patients with CUP, 13 were shown to be positive for HPV DNA, amounting to 22% of the study population. In addition, we were able to show a clear disease-free and overall-survival benefit in the HPV-positive group, with a hazard ratio of 0.16 (95% CI: 0.038–0.67) for over-all survival. This survival benefit was also apparent when adjusted for advanced age in a multivariate Cox regression analysis.ConclusionA fairly large percentage of CUP cases are HPV-related, and because this is related to both the location and prognosis, we recommend HPV testing as part of the diagnostic work-up.

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“…This might be altered in cases of human papillomavirus (HPV) positive tumors, in which patients do present with advanced neck disease (Mollenhauer et al, 2014). The rates of distant metastasis between CUP and HNSCC patients are comparable (Perkins et al, 2012). According to the literature, CUP patients demonstrate improved overall survival despite a more advanced nodal stage, a higher incidence of ECS, and more advanced age.…”

Section: Discussionmentioning

confidence: 90%

Unknown primary of the head and neck: A long-term follow-up

Lanzer¹,

Bachna-Rotter²,

Graupp³

et al. 2015

Journal of Cranio-Maxillofacial Surgery

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Radiotherapeutic Management of Cervical Lymph Node Metastases From an Unknown Primary Site

Abstract: IPSI radiation therapy demonstrated excellent locoregional control with no adverse effect on disease-free survival or overall survival.

Cited by 62 publications

References 21 publications

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

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

Human Papillomavirus in Head and Neck Squamous Cell Carcinoma of Unknown Primary Is a Common Event and a Strong Predictor of Survival

Unknown primary of the head and neck: A long-term follow-up

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