Five-year outcomes of an oropharynx-directed treatment approach for unknown primary of the head and neck

Publication date: July 2017
Source:Oral Oncology, Volume 70
Author(s): Kenneth Shung Hu, Waleed Fouad Mourad, Mauricio E. Gamez, Wilson Lin, Adam Saul Jacobson, Mark Stephen Persky, Mark L. Urken, Bruce E. Culliney, Zujun Li, Theresa Nguyen Tran, Stimson Pryor Schantz, Juskaran Chadha, Louis Benjamin Harrison
PurposeSquamous cell carcinoma of unknown primary (SCCHNUP) is commonly treated with comprehensive radiation to the laryngopharynx and bilateral necks. In 1998, we established a departmental policy to treat SCCHNUP with radiation directed to the oropharynx and bilateral neck.MethodsFrom 1998–2011, 60 patients were treated – N1: 18%, N2: 75% and N3: 7%. 82% underwent neck dissection. 55% received IMRT and 62% underwent concurrent chemoradiotherapy.ResultsAt median follow-up of 54months, 5 patients failed regionally and 4 emerged with a primary (tongue base, hypopharynx and thoracic esophagus). Five-year rates of regional control, primary emergence, distant metastasis, disease-free survival and overall survival were 90%, 10%, 20%, 72% and 79%, respectively. The 5year rate of primary emergence in a non-oropharynx site was 3%.ConclusionThis is the first demonstration that an oropharynx-directed approach yields low rates of primary emergence in SCCHNUP with excellent oncologic outcomes.



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