Benefit of postoperative chemoradiotherapy for patients with unknown primary squamous cell carcinoma of the head and neck

✍ Scribed by Nasfat J. Shehadeh; John F. Ensley; Omer Kucuk; Carri Black; George H. Yoo; John Jacobs; Ho-Sheng Lin; Lance K. Heilbrun; Daryn Smith; Harold Kim

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 221 KB
• Volume: 28
• Category: Article
• ISSN: 1043-3074
• DOI: 10.1002/hed.20470

✦ Synopsis

Background. Postopertative adjuvant chemoradiotherapy recently became an established modality for patients with selected high-risk locally advanced head and neck cancers. The optimal treatment of unknown primary squamous cell cancer of the head and neck (SCCHN) continues to be controversial, since major randomized studies excluded those patients.

Methods. We conducted a retrospective review of patients treated during 1995 to 2002 for unknown primary SCCHN. All patients were treated with a neck dissection followed by concurrent high-dose cisplatin (100 mg/m 2 ) and bilateral neck radiotherapy.

Results. Thirty-seven patients were identified with nodal disease distribution of N1 (5%), N2a (22%), N2b (41%), N2c (8%), N3 (22%), and Nx (3%). Modified neck dissection was done on the majority (30/37 ¼ 81%) of patients. With a median follow-up of 42 months among the survivors, very few patients had regional recurrence (5%) or distant failure (11%), and 89% of patients were alive. The actuarial 5-year overall survival rate could not be estimated because there were no deaths beyond 20 months after surgery. Substantial yet acceptable acute and late morbidities were demonstrated in this cohort of patients.

Conclusions. Postoperative chemoradiotherapy is of potential benefit to patients with unknown primary SCCHN by improving survival and reducing failures. This treatment warrants further prospective evaluation. V