Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary

Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy,...

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Bibliographic Details
Published in:Cancers Vol. 13; no. 10; p. 2416
Main Authors: Abu-Shama, Yazan, Salleron, Julia, Carsuzaa, Florent, Sun, Xu-Shan, Pflumio, Carole, Troussier, Idriss, Petit, Claire, Caubet, Matthieu, Beddok, Arnaud, Calugaru, Valentin, Servagi-Vernat, Stephanie, Castelli, Joël, Miroir, Jessica, Krengli, Marco, Giraud, Paul, Romano, Edouard, Khalifa, Jonathan, Doré, Mélanie, Blanchard, Nicolas, Coutte, Alexandre, Dupin, Charles, Sumodhee, Shakeel, Tao, Yungan, Roth, Vincent, Geoffrois, Lionel, Toussaint, Bruno, Nguyen, Duc Trung, Faivre, Jean-Christophe, Thariat, Juliette
Format: Journal Article
Language:English
Published: Basel MDPI AG 17.05.2021
MDPI
Subjects:
Cancer
Cancer therapies
Chemotherapy
Dissection
Head & neck cancer
Head and neck carcinoma
Life Sciences
Medical prognosis
Metastasis
Multivariate analysis
Otolaryngology
Patients
Radiation therapy
Santé publique et épidémiologie
Squamous cell carcinoma
Toxicity
United States > US
unknown primary
chemoradiotherapy
head and neck
neck dissection
neoplasms/cancers/carcinomas
prognosis
ISSN:2072-6694, 2072-6694
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Summary:Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.
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ISSN:2072-6694
2072-6694
DOI:10.3390/cancers13102416