Evan M Graboyes1, Parul Sinha1, Wade L Thorstad2, Jason T Rich1, Bruce H Haughey1. 1. Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri. 2. Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri.
Abstract
BACKGROUND: Amidst a rising incidence of p16-positive (p16+) oropharyngeal cancer, a significant number of cases present as regionally metastatic disease with an "unknown" primary. Preliminary data support transoral surgery as an effective method of primary detection/treatment. METHODS: An observational cohort study of 65 p16+ unknown primary patients treated with transoral surgery and neck dissection (2001-2012) was performed. Adjuvant therapy and recurrence data were collected. Kaplan-Meier estimates were computed for disease-specific survival (DSS) and overall survival (OS). RESULTS: The primary detection rate was 89% (58 of 65). Five-year DSS and OS were 98% and 97% for the detected group and 100% for the undetected, respectively. Seventeen patients were treated with surgery alone. Of the 47 patients receiving adjuvant therapy, radiation to the pharynx was spared in 36. CONCLUSION: The transoral approach was highly effective for the diagnosis and treatment of the p16+ unknown primary and laid the foundation for deescalated radiation by elimination of the pharyngeal field.
BACKGROUND: Amidst a rising incidence of p16-positive (p16+) oropharyngeal cancer, a significant number of cases present as regionally metastatic disease with an "unknown" primary. Preliminary data support transoral surgery as an effective method of primary detection/treatment. METHODS: An observational cohort study of 65 p16+ unknown primary patients treated with transoral surgery and neck dissection (2001-2012) was performed. Adjuvant therapy and recurrence data were collected. Kaplan-Meier estimates were computed for disease-specific survival (DSS) and overall survival (OS). RESULTS: The primary detection rate was 89% (58 of 65). Five-year DSS and OS were 98% and 97% for the detected group and 100% for the undetected, respectively. Seventeen patients were treated with surgery alone. Of the 47 patients receiving adjuvant therapy, radiation to the pharynx was spared in 36. CONCLUSION: The transoral approach was highly effective for the diagnosis and treatment of the p16+ unknown primary and laid the foundation for deescalated radiation by elimination of the pharyngeal field.
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Authors: Francisco J Civantos; Jan B Vermorken; Jatin P Shah; Alessandra Rinaldo; Carlos Suárez; Luiz P Kowalski; Juan P Rodrigo; Kerry Olsen; Primoz Strojan; Antti A Mäkitie; Robert P Takes; Remco de Bree; June Corry; Vinidh Paleri; Ashok R Shaha; Dana M Hartl; William Mendenhall; Cesare Piazza; Michael Hinni; K Thomas Robbins; Ng Wai Tong; Alvaro Sanabria; Andres Coca-Pelaz; Johannes A Langendijk; Juan Hernandez-Prera; Alfio Ferlito Journal: Front Oncol Date: 2020-11-10 Impact factor: 6.244