title: Initial experience with oropharynx-targeted radiation therapy for metastatic squamous cell carcinoma of unknown primary of the head and neck.
abstract: OBJECTIVE
  Metastasis of unknown primary (MUP) is commonly treated with radiation therapy (RT) to the entire mucosal surfaces and bilateral neck nodes (LN). We report outcomes of oropharynx-targeted RT, retropharyngeal nodes (RPN) and bilateral LN in this context.
  
  
  METHODS
  Single-Institution retrospective study of 68 patients. Forty percent were treated with intensity-modulated radiation therapy (IMRT). Fifty-six percent received concurrent chemoradiotherapy (CCRT). The median age was 58 years, 82% were Caucasian, and 75% males. Stage III disease was present in 9%, stage IVA in 75% and IVB in 16%.
  
  
  RESULTS
  At a median follow-up of 3.5 years, the actuarial locoregional control was 95.5%. The emergence of primary developed in 1patient (1.5%) and 2patients (3%) failed in the neck. The median time-to-locoregional failure (LRF) was 18 months. Actuarial long-term RT toxicity was grade 1 xerostomia (68%), dysphagia (35%), neck stiffness (15%) and trismus (6%).
  
  
  CONCLUSIONS
  RT to the oropharynx, RPN, and bilateral neck provides excellent oncological and functional outcomes in MUP in non-Asian patients. Sparing the mucosal surfaces of the nasopharynx, hypopharynx, and larynx seems reasonable without impacting on survival and locoregional control.
authors.affiliation: Department of Radiation Oncology, Beth Israel Medical Center (BIMC), Continuum Cancer Centers of New York (CCCNY), 10 Union Square E. Suite 4 G, New York, NY 10003, U.S.A. Waleed246@gmail.com.
authors.forename: Waleed F
authors.initials: WF
authors.lastname: Mourad
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Hu
authors.forename: Daniel
authors.initials: D
authors.lastname: Shasha
authors.forename: Catherine
authors.initials: C
authors.lastname: Concert
authors.forename: Dan
authors.initials: D
authors.lastname: Ishihara
authors.forename: Wilson
authors.initials: W
authors.lastname: Lin
authors.forename: Rania A
authors.initials: RA
authors.lastname: Shourbaji
authors.forename: Magdalena
authors.initials: M
authors.lastname: Ryniak
authors.forename: Mauricio E
authors.initials: ME
authors.lastname: Gamez
authors.forename: John N
authors.initials: JN
authors.lastname: Lukens
authors.forename: Zujun
authors.initials: Z
authors.lastname: Li
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Culliney
authors.forename: Azita S
authors.initials: AS
authors.lastname: Khorsandi
authors.forename: Theresa
authors.initials: T
authors.lastname: Tran
authors.forename: Adam
authors.initials: A
authors.lastname: Jacobson
authors.forename: Spiros
authors.initials: S
authors.lastname: Manolidis
authors.forename: Stimson
authors.initials: S
authors.lastname: Schantz
authors.forename: Mark
authors.initials: M
authors.lastname: Urken
authors.forename: Mark S
authors.initials: MS
authors.lastname: Persky
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000473:pathology / Q000532:radiotherapy*; D009960:Oropharynx / Q000528:radiation effects*; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D055815:Young Adult
keywords: Metastatic unknown primary cancer squamous cell carcinoma; oropharynx-targeted radiation therapy concurrent chemoradiotherapy