Lovisa Farnebo1, Göran Laurell2, Antti Mäkitie3,4. 1. a Department of Otorhinolaryngology, Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden. 2. b Department of Clinical Sciences, ENT , Uppsala University , Uppsala , Sweden. 3. c Department of Otorhinolaryngology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland. 4. d Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden.
Abstract
CONCLUSION: The management of Head and Neck Cancer of Unknown Primary (HNCUP) patients varies both between centres within and also between the Nordic countries. This study contributes to a continuing discussion of how to improve the accuracy of diagnosis and quality of treatment of HNCUP patients. OBJECTIVES: The initiative for this study was based on the lack of common guidelines for diagnostic procedures and for treatment of HNCUP patients in the Nordic countries constituting a region having a rather homogeneous population. METHOD: A structured questionnaire was sent to all university hospitals in the five Nordic countries. RESULTS: Four of the five Nordic countries use either national guidelines or specific protocols when handling HNCUP. The main diagnostic tools are PET-CT, fine needle aspiration, endoscopic evaluation with biopsies, and most often bilateral tonsillectomy. At 21 of 22 university hospitals the treatment decision is made at a multidisciplinary conference. Three of seven Swedish centres use only radiotherapy or chemoradiotherapy to treat N+ HNCUP patients. Robotic surgery for biopsy of the tongue base is beginning to become an alternative to targeted biopsies in Sweden and Finland. Narrow Band Imaging is used only in Finland.
CONCLUSION: The management of Head and Neck Cancer of Unknown Primary (HNCUP) patients varies both between centres within and also between the Nordic countries. This study contributes to a continuing discussion of how to improve the accuracy of diagnosis and quality of treatment of HNCUP patients. OBJECTIVES: The initiative for this study was based on the lack of common guidelines for diagnostic procedures and for treatment of HNCUP patients in the Nordic countries constituting a region having a rather homogeneous population. METHOD: A structured questionnaire was sent to all university hospitals in the five Nordic countries. RESULTS: Four of the five Nordic countries use either national guidelines or specific protocols when handling HNCUP. The main diagnostic tools are PET-CT, fine needle aspiration, endoscopic evaluation with biopsies, and most often bilateral tonsillectomy. At 21 of 22 university hospitals the treatment decision is made at a multidisciplinary conference. Three of seven Swedish centres use only radiotherapy or chemoradiotherapy to treat N+ HNCUP patients. Robotic surgery for biopsy of the tongue base is beginning to become an alternative to targeted biopsies in Sweden and Finland. Narrow Band Imaging is used only in Finland.
Entities:
Keywords:
Cancer of unknown origin; PET-CT; follow up; multidisciplinary tumour board meeting
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