Summary
This review has highlighted the paucity of evidence relevant to contemporary practice for HNSCCUP. The studies identified are heterogenous and span a timeframe from 1969-2018 during which oncogenesis and diagnostic strategies have evolved considerably, limiting interpretability of the findings. Crude interpretation of the data may suggest ND alone is a reasonable treatment consideration for select patients with p16 positive N1 (TNM7) disease without ECS. For patients with p16 negative disease the potential primary site is more varied, and outcomes were inferior with ND alone, given the high rates of primary emergence. For p16 negative patients it is likely that multi-modality treatment is nearly always indicated for optimal survival outcomes.
Whilst a prospective randomised control trial would prove highly valuable in further defining optimal management strategies, given the rarity and heterogeneity of this disease entity, patient accrual is likely to be a significant barrier. Multi centre studies examining treatment outcomes in a contemporary era of practice may be more informative. Given the recent updates to AJCC/UICC TNM8 guidelines where p16 positive HNSCCUP is to be treated along oropharynx paradigms; extrapolation from relevant studies may be appropriate. For example, recent randomised control trial data from ECOG 3311(6) report a 2-yr PFS of 96.9% for a group of patients with T1-2, N0-1 (TNM 7) oropharynx cancer treated with surgery alone (27/38 patients N1 disease, no ECS)