Is it ever appropriate to treat just the ipsilateral oropharynx and neck for head and neck cancer of unknown primary?

I usually treat the bilateral neck, because half of the unknown primaries are likely in the base of the tongue, unless there’s a really good reason to reduce toxicity. And there usually isn’t.

Absolutely. The only time I treat contralateral neck electively is when there are multilevel ipsilateral adenopathy or very large single node with possible ECE. I have never had an isolated contralateral neck recurrence.

This question was explored by the Danish and then in a series from Loyola.

The Danish reviewed their experience in 350 pts and demonstrated that bilateral neck irradiation resulted in improved LRC and DSS. The Loyola group demonstrated c/l failure rate and mucosal primary emergence rates of 45% vs 15% for unilateral vs bilateral neck irradiation.

A different way to approach this question is to explore the data for N1 disease. In pts who undergo neck dissection alone, there is an improvement with t...

The key to success with unilateral neck only treatment in the management of squamous call ca of unknown primary is careful selection of patients after a comprehensive surgical work up that addresses the putative mucosal sites of origin. Only after such a work up can the case be staged as a pT0. Of late, TORS based mucosal/lymphoid resection of the tongue base has added an extra layer of confidence that the lingual tonsil of the tongue base has been successfully explored along with the palatine t...