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DOI: 10.1055/s-0045-1806744
Patterns of Failure in Head and Neck Carcinoma of Unknown Primary: Insights from a Tobacco-Associated Cancer Cohort
Abstract
Objective
We report the patterns of failure and survival with carcinoma of unknown primary of the head and neck (CUP-HN).
Materials and Methods
This is a retrospective audit of CUP-HN patients treated with curative radiotherapy (RT) between January 2006 and December 2020. All patients received RT to the neck—definitive RT (DRT) or surgery (Sx) + adjuvant RT (ART), ± chemotherapy.
Results
Of the 108 eligible patients, 81 (75%) used tobacco. Positron emission tomography with computed tomography was performed in 102 patients (94.4%). Seventy-five patients (69.4%) were treated with DRT ± chemotherapy, while 33 (30.6%) underwent Sx + ART ± chemotherapy. Median lymph node size was significantly different between DRT and ART groups (5 vs. 3.5cm, p = 0.001). At a median follow-up of 60 months, 35.1% patients had a neck failure (within treatment portal 37, outside portal 1). Nine patients (8.3%) developed 10 sites of subsequent mucosal primary (SMP)—all occurred in the oral cavity, six of whom had received comprehensive mucosal irradiation (CMI). Three-year survival outcomes were significantly better with Sx + ART compared to DRT (local control in neck: 96.8 ± 3.2 vs. 50.6 ± 6.2, p < 0.001, locoregional control: 89.7 ± 5.7 vs. 48.6 ± 6.3, p < 0.001), progression-free survival: 80.7 ± 7.1 vs. 38.7 ± 6, p < 0.001, and overall survival [OS]: 67.2 ± 8.5 vs. 41.9 ± 6.2, p = 0.01), respectively. After propensity score matching, all survival outcomes (except OS) were better with Sx + ART compared to DRT.
Conclusion
All SMPs developed in the oral cavity in this tobacco-driven population. Inclusion of oral cavity for CMI may be considered in tobacco-driven populations; however, this has to be weighed against the toxicity involved.
Data Sharing Policy
Data is stored in the institutional repository and can be made available from the corresponding author on reasonable request.
Publikationsverlauf
Eingereicht: 11. Januar 2025
Angenommen: 06. Februar 2025
Artikel online veröffentlicht:
31. März 2025
© 2025. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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