Mona Kamal1,2, Abdallah S R Mohamed1,3, Clifton David Fuller1, Erich M Sturgis4, Faye M Johnson5,6, William H Morrison1, G Brandon Gunn1, Katherine A Hutcheson4, Jack Phan1, Stefania Volpe1,7, Sweet Ping Ng1, Renata Ferrarotto5, Steven J Frank1, Heath D Skinner1, David I Rosenthal1, Adam S Garden1. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 3. Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. 4. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. The University of Texas Graduate School of Biomedical Sciences, Houston, Texas. 7. University of Milan, Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.
Abstract
BACKGROUND: There are few published studies to guide the treatment of carcinoma metastatic to the neck from an unknown primary (CUP). In this regard, the objective of the current study was to share the authors' current experience treating patients with CUP using intensity-modulated radiation therapy (IMRT), which principally targeted both sides of the neck, the nasopharynx, and the oropharynx. METHODS: This was a retrospective study in which an institutional database search was conducted to identify patients with CUP who received IMRT. Data analysis included frequency tabulation, survival analysis, and multivariable analysis. RESULTS: Two-hundred sixty patients met inclusion criteria. The most common lymph node category was N2b (54%). IMRT volumes included the entire pharyngolaryngeal mucosa in 78 patients, the nasopharynx and oropharynx in 167 patients, and treatment limited to the involved neck in 11 patients. Eighty-four patients underwent neck dissections. The 5-year overall survival, regional control, and distant metastases-free survival rates were 84%, 91%, and 94%, respectively. Over 40% of patients had gastrostomy tubes during therapy, and 7% patients were diagnosed with chronic radiation-associated dysphagia. Higher lymph node burden was associated with worse disease-related outcomes, and in subgroup analysis, patients with human papillomavirus-associated disease had better outcomes. No therapeutic modality was statistically associated with either disease-related outcomes or toxicity. CONCLUSIONS: Comprehensive IMRT with treatment to both sides of the neck and to the oropharyngeal and nasopharyngeal mucosa results in high rates of disease control and survival. The investigators were unable to demonstrate that treatment intensification with chemotherapy or surgery added benefit or excessive toxicity. Cancer 2018;124:1415-27.
BACKGROUND: There are few published studies to guide the treatment of carcinoma metastatic to the neck from an unknown primary (CUP). In this regard, the objective of the current study was to share the authors' current experience treating patients with CUP using intensity-modulated radiation therapy (IMRT), which principally targeted both sides of the neck, the nasopharynx, and the oropharynx. METHODS: This was a retrospective study in which an institutional database search was conducted to identify patients with CUP who received IMRT. Data analysis included frequency tabulation, survival analysis, and multivariable analysis. RESULTS: Two-hundred sixty patients met inclusion criteria. The most common lymph node category was N2b (54%). IMRT volumes included the entire pharyngolaryngeal mucosa in 78 patients, the nasopharynx and oropharynx in 167 patients, and treatment limited to the involved neck in 11 patients. Eighty-four patients underwent neck dissections. The 5-year overall survival, regional control, and distant metastases-free survival rates were 84%, 91%, and 94%, respectively. Over 40% of patients had gastrostomy tubes during therapy, and 7% patients were diagnosed with chronic radiation-associated dysphagia. Higher lymph node burden was associated with worse disease-related outcomes, and in subgroup analysis, patients with human papillomavirus-associated disease had better outcomes. No therapeutic modality was statistically associated with either disease-related outcomes or toxicity. CONCLUSIONS: Comprehensive IMRT with treatment to both sides of the neck and to the oropharyngeal and nasopharyngeal mucosa results in high rates of disease control and survival. The investigators were unable to demonstrate that treatment intensification with chemotherapy or surgery added benefit or excessive toxicity. Cancer 2018;124:1415-27.
Authors: Mona Kamal; Abdallah S R Mohamed; Clifton David Fuller; Erich M Sturgis; Faye M Johnson; William H Morrison; G Brandon Gunn; Katherine A Hutcheson; Jack Phan; Stefania Volpe; Sweet Ping Ng; Jae Phan; Carlos Cardenas; Renata Ferrarotto; Steven J Frank; David I Rosenthal; Adam S Garden Journal: Adv Radiat Oncol Date: 2020-05-15
Authors: Alexander D Sherry; Dario Pasalic; G Brandon Gunn; C David Fuller; Jack Phan; David I Rosenthal; William H Morrison; Erich M Sturgis; Neil D Gross; Maura L Gillison; Renata Ferrarotto; Adel K El-Naggar; Adam S Garden; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25