Head and neck squamous cell carcinoma from an unknown primary site

Wallace, Audrey; Richards, Greg M.; Harari, Paul M.; Kirwan, Jessica M.; Morris, Christopher G.; Katakam, Haritha; Mendenhall, William M.

doi:10.1016/j.amjoto.2010.05.004

« Previous Next »American Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume 32, Issue 4 , Pages 286-290, July 2011

Head and neck squamous cell carcinoma from an unknown primary site☆

Audrey Wallace, MSN
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Greg M. Richards, MD
- Department of Human Oncology, University of Wisconsin College of Medicine, Madison, WI, USA
Paul M. Harari, MD
- Department of Human Oncology, University of Wisconsin College of Medicine, Madison, WI, USA
Jessica M. Kirwan, MA
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Christopher G. Morris, MS
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
Haritha Katakam, BS
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
William M. Mendenhall, MD
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
- Corresponding author. Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Rd, PO Box 100385, Gainesville, FL 32610-0385, USA. Tel.: +1 352 265 0287; fax: +1 352 265 0759.

Received 9 March 2010 published online 19 August 2010.

Abstract

Background

The purpose of this study is to present our experience treating patients with squamous cell carcinoma (SCC) from an unknown head and neck primary site and to determine whether a policy change eliminating the larynx and hypopharynx from the radiotherapy (RT) portals has impacted outcome.

Methods

One hundred seventy-nine patients received definitive RT with or without a neck dissection for SCC from an unknown head and neck primary site. RT was delivered to the ipsilateral neck alone or both sides of the neck and, usually, the potential mucosal primary sites. The median mucosal dose was 5670 cGy. The median neck dose was 6500 cGy. One hundred nine patients (61%) received a planned neck dissection.

Results

Mucosal control at 5 years was 92%. The mucosal control rate in patients with RT limited to the nasopharynx and oropharynx was 100%. The 5-year neck-control rates were as follows: N₁, 94%; N_2a, 98%; N_2b, 86%; N_2c, 86%; N₃, 57%; and overall, 81%. The 5-year cause-specific survival rates were as follows: N₁, 94%; N_2a, 88%; N_2b, 82%; N_2c, 71%; N₃, 48%; and overall, 73%. The 5-year overall survival rates were as follows: N₁, 50%; N_2a, 70%; N_2b, 59%; N_2c, 45%; N₃, 34%; and overall, 52%. Eleven patients (7%) developed severe complications.

Conclusion

RT alone or combined with neck dissection results in a high probability of cure with a low risk of severe complications. Eliminating the larynx and hypopharynx from the RT portals did not compromise outcome and likely reduces treatment toxicity.