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- Title
Pharyngeal-sparing radiation for head and neck carcinoma of unknown primary following TORS assisted work-up.
- Authors
Grewal, Amardeep S.; Rajasekaran, Karthik; Cannady, Steven B.; Chalian, Ara A.; Ghiam, Alireza F.; Lin, Alexander; LiVolsi, Virginia; Lukens, John N.; Mitra, Nandita; Montone, Kathleen T.; Newman, Jason G.; O'Malley, Bert W.; Rassekh, Christopher H.; Weinstein, Gregory S.; Swisher‐McClure, Samuel; O'Malley, Bert W Jr.,; Swisher-McClure, Samuel
- Abstract
<bold>Objective: </bold>In patients with head and neck carcinoma of unknown primary (HNCUP;pT0) following TORS-assisted workup, we have adopted a pharyngeal-sparing radiation therapy (PSRT) approach targeting only the at-risk neck and omitting treatment of the pharynx. We report outcomes following PSRT, and compare to institutional historical control subjects who received pharyngeal-targeted RT (PRT).<bold>Methods: </bold>Between 2009 and 2018, 172 patients underwent TORS-assisted endoscopy as part of their workup for HNCUP. Following TORS, 54 patients had pT0 disease, of which 45 received RT. Forty-nine percent received PSRT and 51% received PRT.<bold>Results: </bold>No statistically significant differences existed between the PSRT and PRT groups with respect to overall nodal distribution, p16 positivity (55% vs. 43%, P = .12), neck dissection rates (77% vs. 65%, P = .51), and administration of chemotherapy (55% vs. 65%, P = .55). Median follow-up for PSRT and PRT groups were 24 and 28 months, respectively (P = .04). Two-year RFS was 86% and 74% for PSRT and PRT patients, respectively (log-rank P = .30). Three and six patients recurred after PSRT and PRT, respectively. Two-year OS for PSRT and PRT patients was 91% and 74%, respectively (log-rank P = .31). Compared to PRT, PSRT was associated with statistically significantly less: grade 2+ mucositis (18% vs. 91%, P < .01), new opioid requirement (27% vs. 91%, P < .01), mean weight loss during RT (6.2 lbs vs. 17.4 lbs, P < .01), feeding tube placement during RT (5% vs. 43%, P < .01), and treatment-related unplanned hospitalizations (9% vs. 39%, P = .04).<bold>Conclusion: </bold>Following TORS-assisted management of patients with pT0 HNCUP, we observed reduced toxicity following PSRT compared to PRT without apparent compromise of disease cure.<bold>Level Of Evidence: </bold>Level 3 evidence, retrospective review comparing cases and controls Laryngoscope, 130:691-697, 2020.
- Subjects
HYPOPHARYNGEAL cancer; NECK; FEEDING tubes; NECK dissection; WEIGHT loss; CANCER of unknown primary origin
- Publication
Laryngoscope, 2020, Vol 130, Issue 3, p691
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.28200