Head and neck squamous cell carcinoma from an unknown primary site

Area of Science:

• Oncology
• Radiation Oncology
• Head and Neck Surgery

Background:

• Squamous cell carcinoma (SCC) of unknown primary in the head and neck presents a unique clinical challenge.
• Treatment strategies aim to achieve high cure rates while minimizing treatment-related morbidity.

Purpose of the Study:

• To review treatment outcomes for patients with SCC of unknown head and neck primary.
• To evaluate the impact of excluding the larynx and hypopharynx from radiotherapy (RT) portals on patient outcomes.

Main Methods:

• A retrospective review of 179 patients treated with definitive RT, with or without neck dissection, for SCC of unknown head and neck primary.
• RT was delivered to the neck and/or mucosal primary sites, with median doses of 5670 cGy (mucosal) and 6500 cGy (neck).

Main Results:

• Five-year mucosal control was 92%, and 100% when RT was limited to the nasopharynx and oropharynx.
• Five-year overall survival rates varied by N stage, ranging from 52% overall.
• Severe complications occurred in 7% of patients.

Conclusions:

• Definitive RT, with or without neck dissection, achieves high cure rates for SCC of unknown head and neck primary.
• Excluding the larynx and hypopharynx from RT portals did not compromise oncologic outcomes.
• This approach may reduce treatment toxicity without sacrificing efficacy.