title: Head and neck squamous cell carcinoma of unknown primary: neck dissection and radiotherapy or definitive radiotherapy.
abstract: BACKGROUND
  Management of head and neck carcinoma from unknown primary (HNCUP) remains controversial, with neck dissection and radiotherapy (RT) or definitive RT both commonly used. The purpose of this study was to characterize HNCUP and retrospectively compare outcomes for patients treated with neck dissection + RT versus definitive RT.
  
  
  METHODS
  From 1994 to 2009, 41 patients with HNCUP underwent either neck dissection + RT (n = 22) or definitive RT ± concurrent chemotherapy (n = 19) at our institution. Treatment outcomes were compared using Kaplan-Meier methods and log-rank test.
  
  
  RESULTS
  There were no differences between patients treated with neck dissection + RT and definitive RT in overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), freedom from locoregional failure (FFLRG), or freedom from distant failure (FFDF). Among 17 patients who underwent neck dissection + RT for whom human papillomavirus (HPV) status could be determined, HPV(+) patients trended toward improved OS (p = .06) and PFS (p = .15).
  
  
  CONCLUSIONS
  Neck dissection and postoperative RT resulted in similar outcomes as definitive RT. The prognostic implications of HPV(+) nodes in HNCUP are similar to those in oropharyngeal primary cancers.
authors.affiliation: Department of Radiation Oncology, Uludag University Faculty of Medicine, Bursa, Turkey; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: Candan
authors.initials: C
authors.lastname: Demiroz
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Vainshtein
authors.affiliation: Department of Radiation Oncology, Saint Savvas Anticancer Institute of Athens, Greece; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: Georgios V
authors.initials: GV
authors.lastname: Koukourakis
authors.affiliation: Division of Oncology, Institute of Radiation Therapy, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: Orit
authors.initials: O
authors.lastname: Gutfeld
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Prince
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Scott
authors.initials: S
authors.lastname: McLean
authors.affiliation: Division of Hematology Oncology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Worden
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Chepeha
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schipper
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, MI Avraham Eisbruch, MD, Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: McHugh
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: human papillomavirus; neck dissection; radiation therapy; unknown primary