Background: About five to 10% of cancers in the head and neck region are neck
squamous cell carcinoma of unknown primary (NSCCUP). Their diagnosis and treatment
are challenging given the risk of missing occult tumors and potential relapse. Recently, we
described human papillomavirus (HPV)-related NSCCUP-patients (NSCCUP-P) as a
subgroup with superior survival. However, standardized diagnostic workup, novel
diagnostic procedures, decision-making in the multidisciplinary tumor board (MDTB)
and multimodal therapy including surgery and post-operative radio-chemotherapy
(PORCT) may also improve survival.
Methods: For assessing the impact of standardized diagnostic processes simultaneously
established with the MDTB on outcome, we split our sample of 115 NSCCUP-P into two
cohorts treated with curative intent from 1988 to 2006 (cohort 1; n = 53) and 2007 to 2018
(cohort 2; n = 62). We compared diagnostic processes and utilized treatment modalities
applying Chi-square tests, and outcome by Kaplan–Meier plots and Cox regression.
Results: In cohort 2, the standardized processes (regular use of [18F]-FDG-PET-CT
imaging followed by examination under anesthesia, EUA, bilateral tonsillectomy and neck
dissection, ND, at least of the affected site) improved detection of primaries (P = 0.026)
mostly located in the oropharynx (P = 0.001). From 66.0 to 87.1% increased ND
frequency (P = 0.007) increased the detection of extracapsular extension of neck
nodes (ECE+) forcing risk factor-adapted treatment by increased utilization of cisplatin-based PORCT that improved 5-years progression-free and overall survival from 60.4 and
45.3 to 67.7% (P = 0.411) and 66.1% (P = 0.025).
Conclusions: Standardized diagnostic workup followed by ND and risk-factor adapted
therapy improves survival of NSCCUP-P.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84361 |
| Date | 28 March 2023 |
| Creators | Wichmann, Gunnar, Willner, Maria, Kuhnt, Thomas, Kluge, Regine, Gradistanac, Tanja, Wald, Theresa, Fest, Sandra, Lordick, Florian, Dietz, Andreas, Wiegand, Susanne, Zebralla, Veit |
| Publisher | Frontiers Research Foundation |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2234-943X, 682088 |
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