Abstract Introduction
Head and neck cancer of unknown primary (HNCUP) is a rare condition whose
prognostic factors that are significant for
survival vary between studies. No randomized
treatment study has been performed thus far, and the optimal
treatment is not established. Objective The present study aimed to explore various
prognostic factors and compare the two main
treatments for HNCUP
neck dissection and (chemo)
radiation vs primary (chemo)
radiation.
Methods A national
multicenter study was performed with data from the Swedish
Head and Neck Cancer Register (SweHNCR) and from the
patients'
medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP
patients were included. The
tumors were HPV-positive in 80%. The overall 5-year
survival rate of
patients treated with curative
intent was 71%. Age (p< 0.001), performance status (p= 0.036), and N stage (p= 0.046) were significant factors for overall
survival according to the multivariable
analysis.
Treatment with
neck dissection and (chemo)
radiation (122
patients) gave an overall 5-year
survival of 73%, and
treatment with primary (chemo)
radiation (87
patients) gave an overall 5-year
survival of 71%, with no significant difference in overall or
disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant
prognostic factors.
Treatment with
neck dissection and (chemo)
radiation and primary (chemo)
radiation gave
similar survival outcomes. A randomized
treatment study that includes
quality of life is needed to establish the optimal
treatment.