Ipsilateral Postoperative Radiotherapy, Bilateral Irradiation Have Comparative Survival Rates in Patients with SCC of Unknown Primary

by Linda Kossoff •

What is the impact on survival of patients with squamous cell carcinoma of unknown primary who were treated with ipsilateral neck dissection and ipsilateral postoperative radiotherapy (PORT), and those who received PORT to both sides of the neck and the pharyngeal axis (BILAX)?

BOTTOM LINE

There is no significant difference in overall survival (OS) and disease-free survival (DFS) rates between patients with squamous cell carcinoma of unknown primary who are treated with ipsilateral neck dissection and ipsilateral PORT and patients treated with BILAX.

BACKGROUND: The most common histology in cervical metastasis is squamous cell carcinoma. In 3% to 9% of head and neck squamous cell carcinoma (HNSCC), the primary tumor remains unidentified. New techniques help identify the primary site in head and neck carcinoma of unknown primary (HNCUP), but substantial heterogeneity exists regarding treatment and management.

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

SYNOPSIS: Researchers retrospectively analyzed 78 patients (49 males, 29 females, mean age 60.7 years) with squamous cell carcinoma who were diagnosed between Jan. 1, 2006, and Dec. 31, 2015, and who received PORT following ipsilateral neck dissection. Thirty-nine patients received ipsilateral PORT (IPSI group) and another 39 patients received BILAX (BILAX group). The endpoints of the study were three-year OS, three-year DFS, and overall late radiation toxicity. The median follow-up duration for all 78 patients was 54 months (5–153 months). During this period, 26 patients died. For the IPSI and BILAX groups, the three-year OS rates were 74.4% and 74.1%, respectively; the three-year DFS rates were 73.8% and 71.4%, respectively. However, there was a significantly lower total toxicity score (16% low/15% moderate/3% high) and rate of xerostomia (15 patients) for patients in the IPSI group as opposed to the BILAX group (4% low/26% moderate/7% high and 31 patients, respectively). Study limitations included that the treatment protocols used at the time of this cohort may have skewed survival rates in favor of ipsilateral PORT.

CITATION: Berzenji D, Monserez DA, Verduijn GM, et al. Treatment of head and neck carcinoma of unknown primary: Cracking a nut with a sledgehammer? Laryngoscope Investig Otolaryngol. 2021;6:211-218.