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Cancer of unknown primary: Does treatment modality make a difference?

Authors

  • Ashley E. Balaker MD,

    Corresponding author
    1. Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA
    • UCLA Division of Head and Neck Surgery, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095
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  • Elliot Abemayor MD, PhD,

    1. Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA
    2. Johnsson Comprehensive Cancer Center at UCLA, Los Angeles, California, U.S.A.
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  • David Elashoff PhD,

    1. Department of Biostatistics , David Geffen School of Medicine at UCLA
    2. Johnsson Comprehensive Cancer Center at UCLA, Los Angeles, California, U.S.A.
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  • Maie A. St. John MD, PhD

    1. Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA
    2. Johnsson Comprehensive Cancer Center at UCLA, Los Angeles, California, U.S.A.
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  • Delivered as an oral presentation at the Triological Society Annual Meeting, Chicago, Illinois, April 29–30, 2011.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

We systematically reviewed the published experience on the treatment outcomes of patients with head and neck cancer of unknown primary (CUP) to determine if treatment modality affects survival outcomes.

Study Design:

Meta-analysis.

Methods:

A comprehensive literature search was performed for articles reporting survival outcomes for CUP in the head and neck published within the last 12 years.

Results:

Eighteen studies with 1,726 patients met the inclusion criteria. All studies reported at least 5-year survival outcomes. Thirteen of the 18 studies also reported 5-year survival based on N stage, and six reported 5-year survival based on presence of extracapsular extension (EC). Overall 5-year survival in the entire group was 48.6%. Five-year survival based on N stage was as follows: N1 = 60.8%, all N2 = 51.1%, N2a = 63.6%, N2b = 42.5%, N2c = 37.5%, and N3 = 26.3%, with P < .001 on multivariate analysis. Patients who underwent surgical treatment with either postoperative radiation or chemoradiation had a 5-year survival of 52.4% compared to 46.6% for those treated with chemoradiation alone; however, this difference was not statistically significant. Patients with EC had a 5-year disease-specific survival of 56.9% compared to 81.5% for those without EC (P = .01).

Conclusions:

In patients with CUP, survival outcomes are most significantly influenced by clinical stage at time of diagnosis. No significant 5-year survival difference was seen between patients treated with radiation or chemoradiation alone when compared to patients who also received surgical treatment.

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