South Asian journal of cancer · 2025
Patterns of Failure in Head and Neck Carcinoma of Unknown Primary: Insights from a Tobacco-Associated Cancer Cohort.
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Laskar Sarbani Ghosh, Manjali Jifmi Jose, Budrukkar Ashwini, Swain Monali, Dutta Debanjali, Kumar Amrendra, Sood Sahil, Sinha Shwetabh, Kumar Anuj, Mohanty Samarpita, Gupta Tejpal, Murthy Vedang, Chaturvedi Pankaj, Chaukar Devendra Arvind, Pai Prathamesh, Pantavaidya Gouri, Deshmukh Anuja, Nair Deepa, Thiagarajan Shivakumar, Vaish Richa, Prabhash Kumar, Joshi Amit, Noronha Vanita, Menon Nandini, Agarwal Jai Prakash
Аннотация
OBJECTIVE: We report the patterns of failure and survival with carcinoma of unknown primary of the head and neck (CUP-HN).
MATERIALS AND METHODS: This is a retrospective audit of CUP-HN patients treated with curative radiotherapy (RT) between January 2006 and December 2020. All patients received RT to the neck-definitive RT (DRT) or surgery (Sx) + adjuvant RT (ART), ± chemotherapy.
RESULTS: Of the 108 eligible patients, 81 (75%) used tobacco. Positron emission tomography with computed tomography was performed in 102 patients (94.4%). Seventy-five patients (69.4%) were treated with DRT ± chemotherapy, while 33 (30.6%) underwent Sx + ART ± chemotherapy. Median lymph node size was significantly different between DRT and ART groups (5 vs. 3.5cm, p = 0.001). At a median follow-up of 60 months, 35.1% patients had a neck failure (within treatment portal 37, outside portal 1). Nine patients (8.3%) developed 10 sites of subsequent mucosal primary (SMP)-all occurred in the oral cavity, six of whom had received comprehensive mucosal irradiation (CMI). Three-year survival outcomes were significantly better with Sx + ART compared to DRT (local control in neck: 96.8 ± 3.2 vs. 50.6 ± 6.2, p < 0.001, locoregional control: 89.7 ± 5.7 vs. 48.6 ± 6.3, p < 0.001), progression-free survival: 80.7 ± 7.1 vs. 38.7 ± 6, p < 0.001, and overall survival [OS]: 67.2 ± 8.5 vs. 41.9 ± 6.2, p = 0.01), respectively. After propensity score matching, all survival outcomes (except OS) were better with Sx + ART compared to DRT.
CONCLUSION: All SMPs developed in the oral cavity in this tobacco-driven population. Inclusion of oral cavity for CMI may be considered in tobacco-driven populations; however, this has to be weighed against the toxicity involved.
MATERIALS AND METHODS: This is a retrospective audit of CUP-HN patients treated with curative radiotherapy (RT) between January 2006 and December 2020. All patients received RT to the neck-definitive RT (DRT) or surgery (Sx) + adjuvant RT (ART), ± chemotherapy.
RESULTS: Of the 108 eligible patients, 81 (75%) used tobacco. Positron emission tomography with computed tomography was performed in 102 patients (94.4%). Seventy-five patients (69.4%) were treated with DRT ± chemotherapy, while 33 (30.6%) underwent Sx + ART ± chemotherapy. Median lymph node size was significantly different between DRT and ART groups (5 vs. 3.5cm, p = 0.001). At a median follow-up of 60 months, 35.1% patients had a neck failure (within treatment portal 37, outside portal 1). Nine patients (8.3%) developed 10 sites of subsequent mucosal primary (SMP)-all occurred in the oral cavity, six of whom had received comprehensive mucosal irradiation (CMI). Three-year survival outcomes were significantly better with Sx + ART compared to DRT (local control in neck: 96.8 ± 3.2 vs. 50.6 ± 6.2, p < 0.001, locoregional control: 89.7 ± 5.7 vs. 48.6 ± 6.3, p < 0.001), progression-free survival: 80.7 ± 7.1 vs. 38.7 ± 6, p < 0.001, and overall survival [OS]: 67.2 ± 8.5 vs. 41.9 ± 6.2, p = 0.01), respectively. After propensity score matching, all survival outcomes (except OS) were better with Sx + ART compared to DRT.
CONCLUSION: All SMPs developed in the oral cavity in this tobacco-driven population. Inclusion of oral cavity for CMI may be considered in tobacco-driven populations; however, this has to be weighed against the toxicity involved.