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Original Article | Open Access

Patterns of care in the radiotherapeutic management of head and neck cancer of unknown primary origin: in search of a standard

Ryan Morse1, Rohit G. Ganju1, Allen M. Chen2 ( )
Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, Kansas, USA
Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, Irvine, School of Medicine University of California, Irvine, California, USA
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Abstract

Objective

To analyze patterns of care in radiotherapy field design for patients treated for head and neck squamous cell carcinoma of unknown primary origin in the modern era.

Methods

From January 2014 to April 2018, 33 patients were treated by intensity-modulated radiation therapy for squamous cell carcinoma metastatic to the cervical lymph nodes of unknown primary origin. A total of 17 patients (52%) were treated by primary radiation; 16 (48%) were treated after surgery. N-classification was N1 (3 patients); N2a (8 patients); N2b (15 patients); N2c (2 patients); and N3 (5 patients). Human papillomavirus status was positive in 19 (58%) and negative in 14 patients (42%).

Results

A total of 15 patients (46%) were treated with classic comprehensive fields to the entirety of the pharyngeal mucosal axis and bilateral cervical necks. Seven patients (21%) received ipsilateral neck radiation only. The total mucosal axis was irradiated in 15 patients (46%). Among the entire population, the nasopharynx and larynx were intentionally omitted in 36% and 48%, respectively. None of the clinical parameters predicted for the use of less-than-comprehensive radiation fields (P > 0.05, for all).

Conclusion

Significant variation exists in the radiotherapeutic management of head and neck unknown primary cancer. Further research to better optimize standards is required.

Keywords

cancercervical metastasishead and neckpatterns of careunknown primary

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Precision Radiation Oncology
Volume 6 Issue 1,
March 2022
Pages 39-45
DOI: 10.1002/pro6.1144
Cite this article:
Morse R, Ganju RG, Chen AM. Patterns of care in the radiotherapeutic management of head and neck cancer of unknown primary origin: in search of a standard. Precision Radiation Oncology, 2022, 6(1): 39-45. https://doi.org/10.1002/pro6.1144

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Received: 19 December 2021
Revised: 26 January 2022
Accepted: 26 January 2022
Published: 09 February 2022
© 2022 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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