Minimizing Chemoradiation Using a Surgical Algorithm for HPV-Associated Cancer of Unknown Primary

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Oncology

Background:

• Many cancers of unknown primary (CUP) are identified as HPV-associated oropharyngeal squamous cell carcinoma.
• Accurate primary tumor localization is crucial for effective treatment and reducing adjuvant therapy.

Purpose of the Study:

• To evaluate the efficacy of transoral robotic surgery (TORS) in identifying the primary tumor in patients with HPV-associated CUP.
• To assess recurrence rates and the necessity of adjuvant therapy following TORS for CUP.

Main Methods:

• Retrospective analysis of 48 patients with HPV-associated CUP who underwent TORS between 2019 and 2022.
• Evaluation of primary tumor identification rate, local recurrence, and adjuvant therapy requirements.

Main Results:

• TORS achieved an 87.5% primary tumor identification rate (42/48 patients).
• 39.5% of patients avoided direct radiation to the primary site, and 20.8% received no radiation.
• No local recurrences were observed, with three patients experiencing regional or distant recurrence.

Conclusions:

• A primary surgical approach, such as TORS, should be considered for all patients diagnosed with HPV-associated CUP.
• Precise tumor localization via TORS, guided by intraoperative pathology and a multidisciplinary approach, optimizes adjuvant therapy decisions.