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Unknown primary head and neck squamous cell carcinoma in the era of fluorodeoxyglucose‐positron emission tomography/CT and intensity‐modulated radiotherapy
Author(s) -
Ridder Mischa,
Klop Martin,
HammingVrieze Olga,
de Boer JanPaul,
Jasperse Bas,
Smit Laura,
Vogel Wouter,
van den Brekel Michiel,
AlMamgani Abrahim
Publication year - 2017
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24762
Subject(s) - medicine , radiation therapy , head and neck cancer , lymph , positron emission tomography , head and neck squamous cell carcinoma , fluorodeoxyglucose , radiology , stage (stratigraphy) , retrospective cohort study , primary tumor , metastasis , nuclear medicine , t stage , carcinoma , cancer , pathology , paleontology , biology
Background The diagnosis and treatment of head and neck carcinoma of unknown primary (CUP) have changed with the introduction of fluorodeoxyglucose‐positron emission tomography (FDG‐PET)/CT and intensity‐modulated radiotherapy (IMRT), with potential implications for outcome. Methods We conducted a retrospective analysis of 80 patients with head and neck CUP who were PET‐staged and treated with curative intention using IMRT between 2006 and 2016 in the Netherlands Cancer Institute. Patient, tumor, and treatment demographics were recorded and oncologic outcomes were analyzed. Results Local control was 100% in mucosal irradiated patients. Regional control was 90%. Ten patients developed distant metastases, which were associated with N3, extracapsular extension (ECE) and lower neck positive lymph nodes. Overall survival (OS) at 5 years was 62% and disease‐specific survival was 78%. ECE, N3 neck, multiple levels of positive lymph nodes, and positive lymph nodes in the lower neck were associated with worse prognosis. Conclusion Locoregional outcome of head and neck CUP managed with modern techniques is good. Future research needs to focus on reducing toxicity and patients prone for distant metastasis.