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Head and neck squamous cell carcinoma of unknown primary - Who can be offered surgery as the sole treatment modality? A systematic review
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  • Arunjit Takhar,
  • Mark Wilkie,
  • Devraj Srinivasan,
  • Emma King
Arunjit Takhar
St George's University Hospitals NHS Foundation Trust Department of ENT Surgery

Corresponding Author:[email protected]

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Mark Wilkie
Royal Adelaide Hospital
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Devraj Srinivasan
NHS Lothian
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Emma King
University Hospitals Dorset NHS Foundation Trust
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Abstract

Objective Evaluate the role of neck dissection (ND) as the sole treatment modality for patients with cervical head and neck squamous cell carcinoma of unknown primary (HNSCCUP). Design Systematic review of observational cohort studies with qualitative synthesis. Setting PubMed, Ovid EMBASE, and Cochrane Controlled register of Trials (CENTRAL) were screened from January 2000 up to October 2021. Participants HNSCCUP patients undergoing ND. Main Outcome Measures The primary outcome was 3-year overall survival (OS). Secondary outcomes included disease-free survival (DFS), primary emergence, regional recurrence, and distant metastasis. Results Fourteen eligible studies were identified, including 1,780 patients, of whom 294 received ND as their sole treatment (seven studies) with 3-year OS ranging from 43.9% to 100%. 3-year DFS was reported in four studies (n=62) ranging from 42.8% to 67.0%. 5-year OS and DFS were available in three studies (n=31), ranging from 36.6% to 75.0%, and 43.6% to 67.0%, respectively. The rate of primary emergence ranged from 11.1% to 33.3% (seven studies, n=157), regional relapse from 0.0% to 50.0% (five studies, n=60), and distant metastasis from 0.0% to 3.3% (three studies, n=45). Patients undergoing ND as a sole treatment had predominantly p16 positive N1 (TNM7) disease without ECS. Conclusion Outcomes for HNSCCUP patients undergoing ND alone range widely in the literature but appear reasonable in a subset of patients with early stage p16 positive disease. Data is lacking for p16 negative disease where the potential primary site is more varied and primary emergence appears more common.
29 May 2023Submitted to Clinical Otolaryngology
29 May 2023Assigned to Editor
29 May 2023Submission Checks Completed
14 Jul 2023Reviewer(s) Assigned
30 Sep 2023Review(s) Completed, Editorial Evaluation Pending
30 Sep 2023Editorial Decision: Revise Major