title: Tailored multimodality therapy guided by a two-step decision making process for head-and-neck cancer of unknown primary.
abstract: BACKGROUND
  There is no consensus on the treatment of head-and-neck cancer of unknown primary (HNCUP). The objective of this study is to report our single institution's experience of a tailored multimodality therapy guided by a two-step decision making process.
  
  
  METHODS
  From January 2007 to November 2013, 92 consecutive patients of HNCUP were treated. 77 patients were treated according the process above, 24 were treated by radiotherapy to the nasopharyngeal site, 7 received neck dissection and radiotherapy to other putative mucosal site, 30 were treated by neck dissection alone, and 16 received neck dissection followed by radiotherapy to the neck. SPSS 20.0 software was used for statistical analysis.
  
  
  RESULTS
  After a median follow-up of 34 months, the 3-year overall survival rate was 84.5%. The 3-year mucosal control rate, neck control rate, distant metastasis-free survival rate and disease-free survival rate were 80.9%, 76.2%, and 92.0%, respectively. Of the 24 patients treated as putative nasopharyngeal carcinoma, no primary emerged from any site. Primary tumor emerged in 14 patients, and no primary emerged in the 31 patients treated with putative site radiation (3-year mucosal control rate: 100% vs. 67.9%, p = 0.010). Of the 46 patients treated with neck dissection with/without postoperative radiation, 14 developed neck recurrence, and patients without postoperative radiation suffered more ipsilateral neck recurrence.
  
  
  CONCLUSIONS
  The two-step decision-making process seem to be reasonable in treating Chinese HNCUP patients. However, this results need to be prospectively validated.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Shengjin
authors.initials: S
authors.lastname: Dou
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qian
authors.affiliation: Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Qinghai
authors.initials: Q
authors.lastname: Ji
authors.affiliation: Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
authors.forename: Zhuoying
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200032, China.
authors.forename: Guopei
authors.initials: G
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009382:Neoplasms, Unknown Primary; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D016896:Treatment Outcome
keywords: cervical lymph node metastasis; head and neck cancer; multimodality therapy; treatment decision; unknown primary carcinoma