Involved Neck Only Versus Mucosal Radiation Therapy for Head and Neck Squamous Cell Cancer of Unknown Primary (HNSCCUP): A National Retrospective Multicenter Cohort Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: Target volumes for irradiation remain ill-defined for head and neck squamous cell cancer of unknown primary (HNSCCUP). The aim of this study was to compare 2 commonly used radiation therapy strategies for patients diagnosed with HNSCCUP: ipsilateral or involved neck only (INO) versus bilateral neck and/or mucosal (MUC) radiation therapy, evaluating disease-related outcomes and enteral feeding rates. METHODS AND MATERIALS: This was a retrospective, observational, multicenter cohort study. Patients diagnosed with unilateral HNSCCUP between 2015 and 2023 who underwent radical (chemo) radiation therapy were eligible for analysis. All patients underwent 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography - Computed Tomography (PET-CT). HNSCCUP was a diagnosis of exclusion made on the basis of negative investigations to detect a primary site. Patient and tumor characteristics, treatment details, toxicities, and disease control were recorded and compared between the 2 radiation therapy strategies. RESULTS: One hundred ninety-five patients were eligible for analysis, 66% had human papillomavirus-associated disease. Seventy-three patients received INO (37%) and 122 patients received MUC radiation therapy (63%). The median duration of follow-up was 58 months (IQR, 42-72 months). The rate of primary site emergence was 2.7% in the INO and 0.8% in the MUC cohorts, P = .56. Five-year overall survival was 80% (95% CI, 70%-90%) for INO and 82% (95% CI, 75%-90%) for MUC radiation therapy, P = .74. Those undergoing INO radiation therapy were more likely to die from HNSCCUP (17.8% vs 5.7%), and those receiving MUC were more likely to die from a non-HNSCCUP cause (15.6% vs 4.1%). The need for enteral feeding ≥12 months from radiation therapy was 5.7% for MUC versus 0% for INO (P = .046). CONCLUSIONS: This is the largest series to date of patients with unilateral HNSCCUP treated radically with radiation therapy in the human papillomavirus and FDG PET-CT era. Acceptably low rates of primary site emergence, lower toxicity, and no difference in overall survival when compared with prophylactic MUC radiation therapy suggest that INO radiation therapy in HNSCCUP may be a feasible alternative in contemporary practice.
Authors: Adam L. Peters, Wai-Yan Poon, Sarah Walters, Zsuzsanna Iyizoba-Ebozue, Clare Hannon, Sarah Kingdon, Kohgulakuhan Yogalingam, Laura Kennedy, Josie Peck, Kirsty Cavanagh, Rania Fernandes, Yifei Wang, Solly Thomas, Michael Rowe, Katarzyna Grellier, Karen MacTier, Mark Baxter, Siona A. Growcott, Adam Muse, Rob Kitson, Osanmofe Gbenebichie, Kirsten Laws, John Hardman, Mary Denholm, Karin Purshouse, Robin Prestwich, Christina Wilson, David J. Noble, Claire Paterson
Institutions: Beatson West of Scotland Cancer Centre, Velindre Cancer Centre, Norfolk and Norwich University Hospital, Torbay Hospital, Torbay and South Devon NHS Foundation Trust, James Cook University Hospital, Ninewells Hospital, Portsmouth Hospitals NHS Trust, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Royal Cornwall Hospital Trust, Royal Cornwall Hospital, Edinburgh Cancer Research, Royal Devon and Exeter Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, Weston Park Cancer Centre, Aberdeen Royal Infirmary, Royal Marsden Hospital, University of Cambridge
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,130
Award: G7813387520
OpenAlex ID: W4416398529