| Title: |
Involved Neck Only Versus Mucosal Radiation Therapy for Head and Neck Squamous Cell Cancer of Unknown Primary (HNSCCUP): A National Retrospective Multicenter Cohort Study |
| Authors: |
A. L. P. Peters, W. Y.; Walters, S.; Iyizoba-Ebozue, Z.; Hannon, C.; Kingdon, S.; Yogalingam, K.; Kennedy, L.; Peck, J.; Cavanagh, K.; Fernandes, R.; Wang, Y.; Thomas, S.; Rowe, M.; Grellier, K.; MacTier, K.; Baxter, M.; Growcott, S. A.; Muse, A.; Kitson, R.; Gbenebichie, O.; Laws, K.; Hardman, J.; Denholm, M.; Purshouse, K.; Prestwich, R.; Wilson, C.; Noble, D. J.; Paterson, C. |
| Contributors: |
Oncology (Department of); Muse, Adam |
| Publisher Information: |
Elsevier |
| Publication Year: |
2026 |
| Collection: |
RD&E Research Repository (Royal Devon and Exeter NHS Foundation Trust) |
| Description: |
PURPOSE: Target volumes for irradiation remain ill-defined for head and neck squamous cell cancer of unknown primary (HNSCCUP). The aim of this study was to compare 2 commonly used radiation therapy strategies for patients diagnosed with HNSCCUP: ipsilateral or involved neck only (INO) versus bilateral neck and/or mucosal (MUC) radiation therapy, evaluating disease-related outcomes and enteral feeding rates. METHODS AND MATERIALS: This was a retrospective, observational, multicenter cohort study. Patients diagnosed with unilateral HNSCCUP between 2015 and 2023 who underwent radical (chemo) radiation therapy were eligible for analysis. All patients underwent 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography - Computed Tomography (PET-CT). HNSCCUP was a diagnosis of exclusion made on the basis of negative investigations to detect a primary site. Patient and tumor characteristics, treatment details, toxicities, and disease control were recorded and compared between the 2 radiation therapy strategies. RESULTS: One hundred ninety-five patients were eligible for analysis, 66% had human papillomavirus-associated disease. Seventy-three patients received INO (37%) and 122 patients received MUC radiation therapy (63%). The median duration of follow-up was 58 months (IQR, 42-72 months). The rate of primary site emergence was 2.7% in the INO and 0.8% in the MUC cohorts, P = .56. Five-year overall survival was 80% (95% CI, 70%-90%) for INO and 82% (95% CI, 75%-90%) for MUC radiation therapy, P = .74. Those undergoing INO radiation therapy were more likely to die from HNSCCUP (17.8% vs 5.7%), and those receiving MUC were more likely to die from a non-HNSCCUP cause (15.6% vs 4.1%). The need for enteral feeding =12 months from radiation therapy was 5.7% for MUC versus 0% for INO (P = .046). CONCLUSIONS: This is the largest series to date of patients with unilateral HNSCCUP treated radically with radiation therapy in the human papillomavirus and FDG PET-CT era. Acceptably low rates of primary site emergence, lower ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(25)06485-5; International journal of radiation oncology, biology, physics; https://hdl.handle.net/11287/623985 |
| DOI: |
10.1016/j.ijrobp.2025.11.013 |
| Availability: |
https://hdl.handle.net/11287/623985; https://doi.org/10.1016/j.ijrobp.2025.11.013 |
| Rights: |
© 2025 The Authors. |
| Accession Number: |
edsbas.74860704 |
| Database: |
BASE |