KEY POINTS
- True unknown primary head and neck squamous cell carcinoma is
increasingly rare with the evolution in diagnostic paradigms. In
addition, changes in oncogenesis (Human papillomavirus related) have
improved prognosis and led to a trend towards treatment de-escalation.
- Due to these issues, there is a paucity of relevant data on treatment
outcomes, which is currently limited to historic observational studies
only.
- Lower survival figures along with higher primary emergence and
regional recurrence rates were observed in patients with p16- (or
undefined p16 status) disease.
- Where populations of studies had higher rates of p16 positivity;
outcomes from early-stage nodal disease (N1 without ECS) were
favourable and there were lower primary emergence and regional
recurrence rates. Primary emergences were often successfully treated
with further curative intent.
- ND alone may be a reasonable treatment in a subset of HNSCCUP, namely
p16+ N1 (TNM7) disease without ECS. For p16- disease it appears
multi-modality treatment is required for optimal survival outcomes.