Transoral robotic surgery for the management of head and neck squamous cell carcinoma of unknown primary

Channir, Hani Ibrahim; Rubek, Niclas; Nielsen, Hans Ulrik; Kiss, Katalin; Charabi, Birgitte; Lajer, Christel; Buchwald, Christian von

doi:10.3109/00016489.2015.1052983

Cited by 39 publications

(38 citation statements)

References 13 publications

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“…In patients who had undergone tonsillectomy and random biopsies, the HPV prevalence was lower (28-52%) (17). Furthermore, the application of robotic surgery to the diagnostic work-up of patients classified as CUP, comprising the removal of lymphoid tissue localised superficially in the base of the tongue, has showed promising results and improvement of the detection rate of the primary tumours (8). Thus, a variation in HPV prevalence in CUP of the head and neck region is to be expected, depending on the diagnostic procedure; furthermore, HPV prevalence differs widely for OPSCC between countries and over time (1,(5)(6)(7).…”

Section: Cup Of the Head And Neck Regionmentioning

confidence: 99%

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Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer

Sivars¹,

Bersani²,

Grün³

et al. 2016

Molecular and Clinical Oncology

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Abstract. Human papillomavirus (HPV), in addition to smoking and alcohol, is a cause of oropharyngeal squamous cell carcinoma (OPSCC), particularly of the tonsils and base of the tongue (TSCC and BOTSCC, respectively). Moreover, HPV-positive TSCC and BOTSCC are associated with a better outcome compared with their HPV-negative counterparts (80 vs. 40% 3-year disease-free survival rate, respectively) and their incidence has increased in several countries. Recently, accumulating evidence of HPV in a considerable proportion of cancers of unknown primary (CUP) in the head and neck region and in a small proportion of hypopharyngeal SCCs has been reported. Furthermore, HPV-positive tumours, particularly cases with HPV DNA positivity in combination with overexpression of p16, also tend to have a better clinical outcome compared with that of the corresponding HPV-negative tumours. This finding is particularly prominent in HPV-positive CUPs of the head and neck region, where the primary tumour likely originates from the oropharynx. Thus, the determination of HPV status and p16 expression may be of value for the diagnosis and treatment of CUP of the head and neck region and may also be of value for hypopharyngeal cancers in the future. However, for hypopharyngeal cancer as well as other non-OPSCCs, additional studies per subsite on the effect of HPV status on survival are required.

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Section: Cup Of the Head And Neck Regionmentioning

confidence: 99%

“…de-escalated RT and chemotherapy, or for minimal invasive surgery, such as robotic surgery (1,8,9). In addition, attention has been directed towards identifying HPV at other head and neck sites.…”

Section: Introductionmentioning

confidence: 99%

Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer

Sivars¹,

Bersani²,

Grün³

et al. 2016

Molecular and Clinical Oncology

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“…TOLM alone has enhanced occult tumour detection rates following lingual tonsillectomy of 61%-68% [8,30] versus 51%-100% for TORS lingual tonsillectomy [28,[31][32][33][34][35][36]. Compared to TOLM lingual tonsillectomy, TORS has the added advantage of superior three-dimensional (3D) high-definition visualisation, wider range of instrument motion with seven degrees of freedom plus the ability to manoeuvre around corners with the help of angled scopes, significant reduction in hand tremors, decreased fatigue, and improved hand-eye coordination [35,37].…”

Section: Tolm Versus Tors Lingual Tonsillectomymentioning

confidence: 99%

Transoral Robotic Surgery and the Unknown Primary

Ofo

Spiers

Kim

et al. 2018

ORL

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Carcinoma of unknown primary (CUP) comprises approximately 1%–5% of all head and neck malignancies. Primary site detection rates for metastatic cervical squamous cell carcinoma (SCC) remain variable, with current diagnostic imaging unable to identify all tumours. Prevailing evidence suggests that most head and neck CUP are located in the oropharynx. Diagnostic surgical efforts have been directed at sampling the entire oropharynx. Present techniques that make this possible include transoral robotic surgery (TORS). TORS Lingual tonsillectomy or tongue base mucosectomy performed in the setting of head and neck CUP increases the detection rate of occult tumour. The indication, surgical technique, evidence base, and controversies of performing TORS in the context of the unknown primary are presented.

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“…According to Durmus et al [41] the PT was identified in 77% of patients (17 of 22) with 80% HPV-positive LNM residing in the palatine tonsil in 59% (13 of 22), and the BOT in 18% (4 of 22). In a study by Channir et al [42] the PT was identified by TORS in 7/13 patients (54%) at the lingual tonsils with HPV-positive LNM in all of these patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of the 8th edition of the UICC TNM classification on staging and survival in patients with neck metastases of unknown primary tumor

Nussbaumer-Vorburger¹,

Förbs²,

Jochum³

et al. 2017

Otorhinolaryngol Head Neck Sur

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Objectives: The aims of this study were to assess the predictive value of HPV-positivity in cervical lymph node metastases for the detection of a primary tumor (PT), to investigate the influence of HPV-positivity in cervical lymph node metastases on tumor control and survival and to analyse the impact of the 8 th edition of the UICC TNM classification on staging and survival.Methods: Neck dissection specimen of 47 consecutively included patients were analysed by PCR-based HPV DNA-testing and p16-immunostaining and survival analysis by Kaplan-Meier and Cox proportional hazard regression models were performed. Results:After standard work-up algorithm in patients with suspected CUP 27/47 patients (57%) remained a CUP whereas in 20/47 (43%) a PT was detected (tonsils, lung, parotid gland, skin). 14/20 (70%) with detected PT and 9/27 (30%) with CUP had HPV-positive cervical lymph node metastases (LNM). Sensitivity, specificity, positive predictive value and negative predictive value of HPV-positivity in LNM for diagnosis of a PT in the oropharynx achieved 65%, 95%, 94% and 69%, respectively. In the subgroup of patients with CUP the 5-year overall/disease specific survival (OS/DSS) of patients with HPV-positive compared to HPVnegative LNM was higher (5y-OS 73% vs. 41%, p=0.01, 5y-DSS 73% vs. 53%, p=0.02). The use of the new UICC TNM classification leads to down staging of 65% of patients with detected PT and 33% with CUP. Furthermore, advanced N-category becomes an important negative prognosticator for OS (N≥2: HR 3.05, 95% CI 1.21-7.67, p=0.01). Conclusion:HPV-positivity in LNM directs the detection of PT in the oropharynx in patients with CUP. One third of LNM in patients with CUP were HPVpositive associated with improved OS and DSS. When applying the 8 th edition advanced N-category and UICC stages are negative prognosticators for survival supporting the role for integration of biomarkes in staging systems.

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Transoral robotic surgery for the management of head and neck squamous cell carcinoma of unknown primary

Abstract: The primary tumour was identified by TORS in seven of the 13 patients (54%) at the lingual tonsils. Human papillomavirus DNA and p16 were positive in all identified primary tumour specimens and in the corresponding lymph node metastases.

Cited by 39 publications

References 13 publications

Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer

Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer

Transoral Robotic Surgery and the Unknown Primary

Impact of the 8th edition of the UICC TNM classification on staging and survival in patients with neck metastases of unknown primary tumor

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