Authors:

*#Ryan Morse, M.D., *Rohit G. Ganju, M.D.,*фAllen M. Chen, M.D.

*Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS
#Department of Radiation Oncology, University of North Carolina Health, Chapel Hill, NC
фDepartment of Radiation Oncology, University of California, Irvine, Health, Orange, CA

Abstract:

Purpose To compare clinical outcomes among patients treated with comprehensive and non-comprehensive radiation fields for squamous cell carcinoma of occult primary origin involving the cervical lymph nodes.
Methods and Materials From January 2014 to April 2018, a total of 33 patients at a single institution were treated by intensity-modulated radiation therapy for squamous cell carcinoma metastatic to the cervical lymph nodes of occult primary origin. Seventeen patients (52%) were treated by primary radiation; 16 (48%) were treated after neck surgery. N-classification was N1 (3 patients); N2a (8 patients); N2b (15 patients); N2c (2 patients); and N3 (5 patients). Human papillomavirus was positive in 19 patients (58%) and negative in 14 patients (42%). Ten patients (30%) were lifelong neversmokers. Concurrent platinum-based chemotherapy was delivered to 26 patients (79%). Patients were categorized as receiving comprehensive (15 patients) or non-comprehensive radiation (18 patients) treatment fields.
Results Twenty-seven patients were alive at the time of this analysis, yielding an overall survival of 82% with a median follow-up time of 27 months (range, 5-65). Cancer-specific survival at 2 years for patients treated comprehensively versus non-comprehensively was 74% and 100%, respectively (p= 0.13). The rate of primary emergence was 6% with no difference observed between groups (p=0.89). The rate of 2-year regional control was 76% and 94% for patients treated comprehensively and non-comprehensively, respectively (p=0.47). The corresponding incidence of Grade 3 acute toxicity was 67% and 45%, respectively (p= 0.20).
Conclusion Radiotherapeutic management for occult primary cancer of the head and neck is subject to widely variable treatment fields. This study failed to identify differences in oncologic outcomes between patients treated with comprehensive and non-comprehensive fields.

Citation:

Allen M. Chen. Comprehensive versus Less-than-Comprehensive Fields in the Radiotherapeutic Management of Unknown Primary Cancer of the Head and Neck. Clinical Imaging and Case Reports 2024.