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Head Neck. 2018 May;40(5):904-916. doi: 10.1002/hed.25028. Epub 2017 Dec 6.

Squamous cell carcinoma of unknown primary of the head and neck: Favorable prognostic factors comparable to those in oropharyngeal cancer.

Author information

1
Department of Radiation Oncology, University of California, San Francisco, California.
2
Department of Pathology, University of California, San Francisco, California.
3
Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California.
4
Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
5
Sacramento Ear, Nose and Throat, Sacramento, California.
6
Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California.
7
Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.

Abstract

BACKGROUND:

Treatment for squamous cell carcinoma (SCC) of unknown primary consists of radiotherapy (RT) +/- chemotherapy or neck dissection +/- adjuvant RT/chemoradiotherapy (CRT). We compared these strategies and identified prognostic factors.

METHODS:

From 1993 to 2015, 75 patients with SCC of unknown primary had RT-based or surgery-based treatment. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Event-time distributions were estimated using the Kaplan-Meier method.

RESULTS:

Five-year OS and DFS for RT-based and surgery-based treatments were similar (OS 73% vs 68%, respectively; DFS 65% vs 64%, respectively). Among 38 patients with p16 data, 76% were p16 positive and showed improved 5-year DFS (90% vs 33%; P = .001) and OS (96% vs 33%; P < .001). Smoking history ≤10 pack-years conferred better 5-year DFS (88% vs 49%; P < .001) and OS (91% vs 59%; P < .001).

CONCLUSION:

RT-based and surgery-based treatments produced similar outcomes. Patients with p16-positive disease with ≤10 pack-years of smoking history and limited nodal stage constitute a "low-risk" group in SCC of unknown primary similar to that in oropharyngeal cancer.

KEYWORDS:

p16; radiation; squamous cell carcinoma; surgery; unknown primary

PMID:
29210145
DOI:
10.1002/hed.25028

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