Topics:
Head and Neck Cancers • Radiation Oncology
What mucosal surfaces do you commonly cover with HPV-positive squamous cell carcinoma of the head and neck of unknown primary?
What doses do you typically utilize? How does your coverage differ from your recommendation if this was an HPV-negative squamous cell carcinoma of the head and neck of unknown primary?
Answer from: Radiation Oncologist at Academic Institution
This is an interesting question. Many radiation oncologists are eliminating the nasopharyngeal mucosa from the field when designing plans for “comprehensive mucosal irradiation” in cases of unknown primary head and neck cancers with HPV or p16 positive squamous histology. I am currently ...
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Answer from: Radiation Oncologist at Academic Institution
Oropharynx bilaterally in the US and Europe. You have to treat the RP nodes so include the nasopharynx with tight margins plus bilateral necks.
Comments
Radiation Oncologist at University of Kentucky/Markey Cancer Center
Totally agree. This is exactly what our experience...
Totally agree. This is exactly what our experience...
Radiation Oncologist at Center for Neurosciences
Is it even possible to spare the pharyngeal constr...
Is it even possible to spare the pharyngeal constr...
Answer from: Radiation Oncologist at Community Practice
In the words of @William M. Mendenhall, "the cervical lymph node area most often involved with cancer from an unknown H&N primary site is level II. The most likely primary tumor sites are the base of tongue and the tonsillar fossa. Accordingly, our philosophy has been to treat the unknown primar...
Comments
Radiation Oncologist at Munson Medical Center
@Manuj Agarwal and @Nicolas Kuritzky, have you exp...
@Manuj Agarwal and @Nicolas Kuritzky, have you exp...
Answer from: Radiation Oncologist at Academic Institution
Worked with ASCO on a guideline paper for unknown primary where we address this: Maghami et al., PMID 32324430. Ultimately, I think the highest risk areas will be ipsilateral oropharynx (tonsil & BoT). These odds probably don't change much between HPV+ and HPV-.
Comments
Radiation Oncologist at University of Wisconsin School of Medicine and Public Health
I have found this paper to be immensely helpful. T...
I have found this paper to be immensely helpful. T...
Answer from: Radiation Oncologist at Academic Institution
For an HPV-associated CUP, if we are covering mucosal sites, we treat the entire oropharynx and nasopharynx. The latter is biased by our a) treating RP nodes, and b) ~ 1/3 of our NPC population is HPV-associated. Granted it is hard to make a strong argument that even more tailored approaches such as...
Answer from: Radiation Oncologist at Academic Institution
Ofo et al., PMID 30419564. None for well selected patients if you believe in TORS/TOLM/SOHND —> observation. Should include in the informed consent discussion.
Answer from: Radiation Oncologist at Academic Institution
The UKP issue is somewhat complex and there are 2 main schools of thought. Treat comprehensively the involved neck + electively the mucosal sites + CL neck vs. only the involved neck. When a surgeon manages an N1 neck w/o RT, he/she is not concerned about CL neck or mucosal sites. To me, the first s...
Answer from: Radiation Oncologist at Community Practice
2 interesting articles on the subject: Perkins et al., PMID 22801890. Distribution of primaries found by random biopsy/tonsillectomy at UF
Tanzler et al., PMID 25488125.
Answer from: Radiation Oncologist at Community Practice
There have been several more series, omitting contralateral neck and elective mucosa depending on the scenario. Guidelines from Spain.Rodríguez et al., PMID 30196912