Radiotherapy Characteristics and Outcomes for Head and Neck Carcinoma of Unknown Primary vs T1 Base-of-Tongue Carcinoma

Hosni, Ali; Dixon, Peter R.; Rishi, Anupam; Au, Michael; Xu, Wei; Song, Yuyao; Goldstein, David P.; Huang, Shao Hui; Kim, John; Waldron, John; Bratman, Scott V.; Almeida, John R. de

doi:10.1001/jamaoto.2016.3083

Cited by 28 publications

(22 citation statements)

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“…There is a current trend favoring the latter approach as it overcomes surgical complications and allows concomitant treatment of the neck and mucosal sites with the potential index tumor. 54,88 The evidence provided by these two studies, however, should not be overinterpreted as it is hypothesized that HPV-related SCCUP might underline more aggressive disease than HPV-related OPSCC as it is associated with multiple additional genomic alterations. A crucial issue in the management of HPV-related SCCUP is to define whether the radiation field should encompass both sides of the neck and the mucosal axis, which is the subject of an ongoing debate.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

2019

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“…Although this is the first study to compare a CUP cohort with a matched OPX cohort, other studies suggest that CUP patients have excellent outcomes. Table demonstrates previous studies on CUP and reports outcomes for all patients regardless of HPV status . Most studies are heterogeneous and include patients with unknown HPV status or HPV‐negative disease and then later stratify by HPV status.…”

Section: Discussionmentioning

confidence: 99%

A matched comparison of human papillomavirus–induced squamous cancer of unknown primary with early oropharynx cancer

et al. 2017

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“…This does not seem justified, since a cT1 tumor (in this case not detected, therefore CUP) generally has an excellent prognosis with RT alone [84, 100]. A recent study by Hosni et al revealed an almost identical prognosis for patients with HNCUP and those with T1 base-of-tongue carcinoma [101]. These data would imply that both diseases may be treated the same way, i.e., without the use of chemotherapy.…”

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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Radiotherapy Characteristics and Outcomes for Head and Neck Carcinoma of Unknown Primary vs T1 Base-of-Tongue Carcinoma

Cited by 28 publications

References 34 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 matched comparison of human papillomavirus–induced squamous cancer of unknown primary with early oropharynx cancer

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

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