Katri Aro1, Leif Bäck1, Antti Mäkitie1,2, Laura Tapiovaara1. 1. a Department of Otorhinolaryngology - Head and Neck Surgery , Helsinki University Central Hospital , Helsinki , Finland. 2. b Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet , Karolinska University Hospital , Stockholm , Sweden.
Abstract
BACKGROUND: Various detection methods to identify the primary in head and neck cancer of unknown primary (HN-CUP) require evaluation to improve and standardize management. OBJECTIVES: To evaluate the use of different diagnostic methods, which aim at decreasing the incidence of HN-CUP. MATERIAL AND METHODS: We conducted a retrospective analysis of patients with HN-CUP at the Helsinki University Hospital during 1995-2011. We evaluated clinical assessment, definitive treatment, histopathology, and follow up. We analyzed the success in identifying the primary site to show any changes in diagnostic methods over time. RESULTS: Frequency of HN-CUP and success in identifying the primary site have remained constant despite the addition of PET-CT and determination of human papilloma virus (HPV) status in diagnostics. Among 133 patients, the diagnostic work up identified the primary site in 53% and the oropharynx predominated (69%). This left 85 patients with HN-CUP and 5-year overall and disease-free survival rates were 71 and 69%, respectively. CONCLUSIONS: Panendoscopy including tonsillectomy should not be omitted in the work up. SIGNIFICANCE: We demonstrate a steady frequency of HN-CUP and constant success in identifying the primary site. Detection of a primary later in the follow up did not impact the survival.
BACKGROUND: Various detection methods to identify the primary in head and neck cancer of unknown primary (HN-CUP) require evaluation to improve and standardize management. OBJECTIVES: To evaluate the use of different diagnostic methods, which aim at decreasing the incidence of HN-CUP. MATERIAL AND METHODS: We conducted a retrospective analysis of patients with HN-CUP at the Helsinki University Hospital during 1995-2011. We evaluated clinical assessment, definitive treatment, histopathology, and follow up. We analyzed the success in identifying the primary site to show any changes in diagnostic methods over time. RESULTS: Frequency of HN-CUP and success in identifying the primary site have remained constant despite the addition of PET-CT and determination of human papilloma virus (HPV) status in diagnostics. Among 133 patients, the diagnostic work up identified the primary site in 53% and the oropharynx predominated (69%). This left 85 patients with HN-CUP and 5-year overall and disease-free survival rates were 71 and 69%, respectively. CONCLUSIONS: Panendoscopy including tonsillectomy should not be omitted in the work up. SIGNIFICANCE: We demonstrate a steady frequency of HN-CUP and constant success in identifying the primary site. Detection of a primary later in the follow up did not impact the survival.
Entities:
Keywords:
Diagnostics; head and neck cancer; metastasis; survival; unknown primary
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