Impact of postoperative target volumes in management of unilateral head and neck carcinoma of unknown primary: a retrospective study

Background:

We aimed to compare the outcomes of postoperative unilateral radiotherapy (UL-RT) versus bilateral radiotherapy plus total mucosal irradiation (COMP-RT) in management of head and neck carcinoma of unknown primary (HNCUP).

Materials and methods:

Retrospectively, 69 patients with unilateral HNCUP treated in 2 cancer institutes between 2004 and 2014 were included. Diagnosis work-up included for all patients a positron emission tomography-computed tomography. All patients were treated with curative intent by initial ipsilateral neck dissection. In one center, all 23 patients underwent UL-RT while in the other center, all 46 patients received a COMP-RT. The long-term quality of life (QOL) of the patient was evaluated using the Quality of Life Questionnaire for Head and Neck 35.

Results:

After a median follow up of 6.3 years, primary tumour emerged in 3 (13%) patients in UL-RT group and in 4 (9%) patients in COMP RT group (p = 0.68). There were no differences (p = 0.34) in cervical node recurrence rate between UL-RT group (4%) and COMP-RT group (22%). The locoregional recurrence free survival rate at 5-years was 81% in UL-RT group and 68.6% in COMP-RT group (p = 0.21). When comparing it with COMP-RT, UL-RT had a trend to an improvement of the QOL related to teeth problems, swallowing, troubles with social contact and use of pain killers.

Conclusion:

Unilateral postoperative radiotherapy provides similar outcomes as COMP-RT in unilateral HNCUP management. This radiotherapy modality seems to improve radiation morbidity and long term QOL of patients without compromising re-irradiation possibilities.

Publication History

Publication Date:
23 April 2019 (online)