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Strahlentherapie und Onkologie

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14.05.2018 | Original Article

Patterns of care analysis for head & neck cancer of unknown primary site: a survey inside the German society of radiation oncology (DEGRO)

verfasst von: Jens Müller von der Grün, MD, Dimitra Bon, PhD, Claus Rödel, MD, Panagiotis Balermpas, MD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 8/2018

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Abstract

Background

Due to the absence of randomized trials, the optimal management for squamous cell cancer of unknown primary in the head and neck region (SCCHN CUP) remains controversial. Current strategies are based on retrospective studies, clinical experience, and institutional policies.

Methods

An anonymous questionnaire with a total of 24 questions was created and distributed by the use of an online version (Google Forms®, Google, Mountain View, CA, USA) as well as a printout version as equivalent option. An email with a link to the survey and the questionnaire as attachment was sent to 361 DEGRO(German Society of Radiation Oncology)-associated departments. Frequency distributions of responses for each question were calculated. The data were also analyzed by type of practice. Representativity of the sample size for the DEGRO was also evaluated.

Results

66 responses were received including answers from 20 (30%) university departments, 16 (24%) non-university institutions, and 30 (46%) radiation oncology practices. 95% of the participants routinely present these cases in an interdisciplinary tumor board and use intensity modulated radiotherapy (IMRT) techniques for SCCHN CUP treatment. Surgery includes neck dissection in 83% and tonsillectomy in 73% of the cases. Human papilloma virus (HPV) status is routinely determined in 82% of the departments. Statistically significant differences between universities and institutions and clinics and practices could be found with respect to positron emission tomography-computed tomography (PET-CT) utilization, indications for chemotherapy, radiotherapy volumes, and cumulative doses.

Conclusion

Diagnostics and treatment for SCCHN CUP within the DEGRO remain heterogeneous. A prospective register trial with standard operation procedures is warranted to homogenize and possibly improve management.

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Pavlidis N, Briasoulis E, Hainsworth J, Greco FA (2003) Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 39(14):1990–2005. https://doi.org/10.1016/S0959-8049(03)00547-1 CrossRefPubMed

Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB (2000) Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 55(2):121–19. https://doi.org/10.1016/S0167-8140(00)00172-9 CrossRefPubMed

Kreimer AR, Clifford GM, Boyle P, Franceschi S (2005) Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomarkers Prev 14(2):467–475. https://doi.org/10.1158/1055-9965.EPI-04-0551 CrossRefPubMed

Jesse RH, Perez CA, Fletcher GH (1973) Cervical lymph node metastasis: unknown primary cancer. Cancer 31(4):854–89. https://doi.org/10.1002/1097-0142(197304)31:4 CrossRefPubMed

Layfield LJ (2007) Fine-needle aspiration in the diagnosis of head and neck lesions: a review and discussion of problems in differential diagnosis. Diagn Cytopathol 35(12):798–805. https://doi.org/10.1002/dc.20769 CrossRefPubMed

Müller von der Grün J, Tahtali A, Ghanaati S, Rodel C, Balermpas P (2017) Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site—current status and challenges. Radiat Oncol 12(1):82. https://doi.org/10.1186/s13014-017-0817-9 CrossRefPubMedPubMedCentral

Galloway TJ, Ridge JA (2015) Management of squamous cancer metastatic to cervical nodes with an unknown primary site. J Clin Oncol 33(29):3328–3337. https://doi.org/10.1200/JCO.2015.61.0063 CrossRefPubMed

Liu X, Li D, Li N, Zhu X (2016) Optimization of radiotherapy for neck carcinoma metastasis from unknown primary sites: a meta-analysis. Oncotarget. https://doi.org/10.18632/oncotarget.12852 CrossRefPubMedPubMedCentral

Krejcie RV (1970) Determining sample size for research activities. Educ Psychol Meas 30(3):607–610. https://doi.org/10.1177/001316447003000308 CrossRef

10.

Machin D, Campbell M, Tan SB, Tan SH (2009) Sample size tables for clinical studies, 3rd edn. Wiley-Blackwell, Chichester

11.

Schaffer AL, Pearson SA, Dobbins TA, Er CC, Ward RL, Vajdic CM (2015) Patterns of care and survival after a cancer of unknown primary (CUP) diagnosis: a population-based nested cohort study in Australian Government Department of Veterans’ Affairs clients. Cancer Epidemiol 39(4):578–584. https://doi.org/10.1016/j.canep.2015.02.007 CrossRefPubMed

12.

Vajdic CM, Schaffer AL, Dobbins TA, Ward RL, Er CC, Pearson SA (2015) Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): a population-based nested case-control study in Australian Government Department of Veterans’ Affairs clients. Cancer Epidemiol 39(4):585–592. https://doi.org/10.1016/j.canep.2015.02.006 CrossRefPubMed

13.

Tribius S, Hoffmann AS, Bastrop S, Gorogh T, Haag J, Rocken C et al (2012) HPV status in patients with head and neck of carcinoma of unknown primary site: HPV, tobacco smoking, and outcome. Oral Oncol 48(11):1178–1184. https://doi.org/10.1016/j.oraloncology.2012.05.022 CrossRefPubMed

14.

Keller LM, Galloway TJ, Holdbrook T, Ruth K, Yang D, Dubyk C et al (2014) p16 status, pathologic and clinical characteristics, biomolecular signature, and long-term outcomes in head and neck squamous cell carcinomas of unknown primary. Head Neck 36(12):1677–1684. https://doi.org/10.1002/hed.23514 CrossRefPubMedPubMedCentral

15.

Yildirim M, von der Muller Grun J, Winkelmann R, Fokas E, Rodel F, Ackermann H et al (2017) Combined p16 and p53 expression in cervical cancer of unknown primary and other prognostic parameters : A single-center analysis. Strahlenther Onkol 193(4):305–314. https://doi.org/10.1007/s00066-017-1102-4 CrossRefPubMed

16.

Johansen J, Buus S, Loft A, Keiding S, Overgaard M, Hansen HS et al (2008) Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 30(4):471–478. https://doi.org/10.1002/hed.20734 CrossRefPubMed

17.

Kwee TC, Kwee RM (2009) Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 19(3):731–744. https://doi.org/10.1007/s00330-008-1194-4 CrossRefPubMed

18.

Al-Ibraheem A, Buck A, Krause BJ, Scheidhauer K, Schwaiger M (2009) Clinical applications of FDG PET and PET/CT in head and neck cancer. J Oncol 2009:208725. https://doi.org/10.1155/2009/208725 CrossRefPubMedPubMedCentral

19.

Haussmann J, Budach W (2017) Zervikale Lymphknotenmetastasen bei unbekanntem Primärtumor. Onkologe:1–6. https://doi.org/10.1007/s00761-017-0266-y CrossRef

20.

Chen AM, Farwell DG, Lau DH, Li BQ, Luu Q, Donald PJ (2011) Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio? Int J Radiat Oncol Biol Phys 81(2):346–352. https://doi.org/10.1016/j.ijrobp.2010.06.031 CrossRefPubMed

21.

Nieder C, Gregoire V, Ang KK (2001) Cervical lymph node metastases from occult squamous cell carcinoma: cut down a tree to get an apple? Int J Radiat Oncol Biol Phys 50(3):727–33. https://doi.org/10.1016/S0360-3016(01)01462-6 CrossRefPubMed

22.

Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP (2001) Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection. Int J Radiat Oncol Biol Phys 50(1):55–63CrossRefPubMed

23.

Richards TM, Bhide SA, Miah AB, Del Rosario L, Bodla S, Thway K et al (2016) Total mucosal irradiation with intensity-modulated radiotherapy in patients with head and neck carcinoma of unknown primary: a pooled analysis of two prospective studies. Clin Oncol (R Coll Radiol) 28(9):e77–e84. https://doi.org/10.1016/j.clon.2016.04.035 CrossRef

24.

Frank SJ, Rosenthal DI, Petsuksiri J, Ang KK, Morrison WH, Weber RS et al (2010) Intensity-modulated radiotherapy for cervical node squamous cell carcinoma metastases from unknown head-and-neck primary site: M. D. Anderson Cancer Center outcomes and patterns of failure. Int J Radiat Oncol Biol Phys 78(4):1005–1010. https://doi.org/10.1016/j.ijrobp.2009.09.006 CrossRefPubMed

25.

Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH et al (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350(19):1945–1952. https://doi.org/10.1056/NEJMoa032641 CrossRefPubMed

26.

Fietkau R, Lautenschläger C, Sauer R, Dunst J, Becker A, Baumann M et al (2006) Postoperative concurrent radiochemotherapy versus radiotherapy in high-risk SCCA of the head and neck: Results of the German phase III trial ARO 96–3. J Clin Oncol 24(18 Suppl):5507–5507. https://doi.org/10.1200/jco.2006.24.18_suppl.5507 CrossRef

27.

Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB et al (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350(19):1937–1944. https://doi.org/10.1056/NEJMoa032646 CrossRefPubMed

28.

Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A et al (2005) Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27(10):843–850. https://doi.org/10.1002/hed.20279 CrossRefPubMed

29.

Eskander A, Ghanem T, Agrawal A, Education Committee of American Head and Neck Society (AHNS). (2018) AHNS Series: Do you know your guidelines? Guideline recommendations for head and neck cancer of unknown primary site. Head Neck 40(3):614–621. https://doi.org/10.1002/hed.25026 CrossRefPubMed

30.

National Comprehensive Cancer Network; NCCN Clinical Practice Guidelines in Oncology: Head and Neck, CUP 1.2018; https://www.nccn.org/professionals/physician_glsf_guidelines.asp. Accessed 3rd March 2018

31.

Weir L, Keane T, Cummings B, Goodman P, O’Sullivan B, Payne D et al (1995) Radiation treatment of cervical lymph node metastases from an unknown primary: an analysis of outcome by treatment volume and other prognostic factors. Radiother Oncol 35(3):206–211. https://doi.org/10.1016/0167-8140(95)01559-Y CrossRefPubMed

32.

Reddy SP, Marks JE (1997) Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation. Int J Radiat Oncol Biol Phys 37(4):797–802. https://doi.org/10.1016/S0360-3016(97)00025-4 CrossRefPubMed

Titel: Patterns of care analysis for head & neck cancer of unknown primary site: a survey inside the German society of radiation oncology (DEGRO)
verfasst von: Jens Müller von der Grün, MD
Dimitra Bon, PhD
Claus Rödel, MD
Panagiotis Balermpas, MD
Publikationsdatum: 14.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 8/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1308-0

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