Standardized diagnostics including bilateral tonsillectomy and neck dissection followed by post-operative treatment favoring radio-chemotherapy improve outcome in neck squamous cell carcinoma of unknown primary patients

About 10 percent of cancers in the head and neck region present with a lump in the neck of a squamous cell carcinoma (NSCCUP) with an occult primary tumor escaping established diagnostic and therapeutic strategies. Randomized controlled trials in NSCCUP are missing and even documentation of NSCCUP patients in registries is mostly error-prone and does not provide information about diagnostic procedures and proportion of identified primaries. In a single-institution cohort of 115 NSCCUP patients split according to the time of establishing our multidisciplinary tumor board into those diagnosed before 2007 and since then, we analyzed diagnostic procedures, identification of initially occult primaries as well as decision-making for risk-adapted treatment regimens for definitive NSCCUP, and outcome differences attributable to potential changes. We provide evidence for improved outcome achieved by standardized diagnostics including PET-CT imaging, decision-making in the multidisciplinary tumor board for bilateral tonsillectomy and neck dissection followed by risk-adapted postoperative treatment favoring radio-chemotherapy as recommended by ASCO and NCCN guidelines. Surgery of the neck (neck dissection) followed by cisplatin-based postoperative radio-chemotherapy improved outcome and should be recommended whenever neck nodes are found bilateral or with extranodal extension. Implementing this sound approach into clinical routine might contribute to improved outcome not limited to survival in NSCCUP patients by choosing the right treatment for the right patient at the right time.

Publication History

Article published online:
12 May 2023