Tailored multimodality therapy guided by a two-step decision making process for head-and-neck cancer of unknown primary
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Shengjin Dou1, Wei Qian1, Qinghai Ji2, Zhuoying Wang2, Guopei Zhu3
1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
2Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
3Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200032, China
Guopei Zhu, email: [email protected]
Zhuoying Wang, email: [email protected]
Keywords: unknown primary carcinoma, cervical lymph node metastasis, multimodality therapy, treatment decision, head and neck cancer
Received: October 22, 2015 Accepted: May 05, 2016 Published: May 20, 2016
Background: There is no consensus on the treatment of head-and-neck cancer of unknown primary (HNCUP). The objective of this study is to report our single institution’s experience of a tailored multimodality therapy guided by a two-step decision making process.
Materials and Methods: From January 2007 to November 2013, 92 consecutive patients of HNCUP were treated. 77 patients were treated according the process above, 24 were treated by radiotherapy to the nasopharyngeal site, 7 received neck dissection and radiotherapy to other putative mucosal site, 30 were treated by neck dissection alone, and 16 received neck dissection followed by radiotherapy to the neck. SPSS 20.0 software was used for statistical analysis.
Results: After a median follow-up of 34 months, the 3-year overall survival rate was 84.5%. The 3-year mucosal control rate, neck control rate, distant metastasis-free survival rate and disease-free survival rate were 80.9%, 76.2%, and 92.0%, respectively. Of the 24 patients treated as putative nasopharyngeal carcinoma, no primary emerged from any site. Primary tumor emerged in 14 patients, and no primary emerged in the 31 patients treated with putative site radiation (3-year mucosal control rate: 100% vs. 67.9%, p = 0.010). Of the 46 patients treated with neck dissection with/without postoperative radiation, 14 developed neck recurrence, and patients without postoperative radiation suffered more ipsilateral neck recurrence.
Conclusions: The two-step decision-making process seem to be reasonable in treating Chinese HNCUP patients. However, this results need to be prospectively validated.
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