Failure pattern and salvage in head and neck cancer of unknown primary: A national study by DAHANCA

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-26 DOI:10.1016/j.radonc.2025.111162

Signe Bergliot Nielsen , Morten Horsholt Kristensen , Anne Ivalu Sander Holm , Ruta Zukauskaite , Christian Rønn Hansen , Christina Caroline Plaschke , Anita Birgitte Gothelf , Bob Smulders , Eva Samsøe Hinsby , Martin Skovmos Nielsen , Patrik Sibolt , Nina Munk Lyhne , Maria Andersen , Mohammad Farhadi , Hanne Primdahl , Christian Maare , Jørgen Johansen , Christian Godballe , Thomas Kjærgaard , Jens Overgaard

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引用次数: 0

Abstract

Background

Failure patterns in patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) depend on disease etiology and treatment type and extent. Treatment strategies may include radiotherapy to address any potential mucosal tumor sites, or alternatively, the omission of mucosal irradiation to permit targeted intervention should a primary tumor subsequently emerge. The Danish 2013 guidelines employed both strategies based on N-classification and Epstein-Barr Virus status, but not Human Papilloma Virus (HPV) status. The present study aimed to analyze failure patterns in a complete, nationwide Danish cohort of patients with HNSCCUP, with a focus on HPV status, treatment targets, and salvage outcomes.

Materials & Methods

All HNSCCUP patients treated in the period 2014 to 2020, were identified in the DAHANCA database. An image-based pattern of failure analysis was conducted to evaluate the extent of primary treatment coverage at sites of recurrence.

Results

In a consecutive cohort of 254 HNSCCUP patients, 43 % had HPV-associated disease (p16 positivity). Treatment modalities included definitive neck dissection (dND) (n = 60) and treatment regiments involving intensity modulated radiotherapy (IMRT, n = 194); either postoperative or primary IMRT with or without adjuvant chemotherapy. 71 patients (28 %) experienced failure within 5 years. Anatomical localization of emerging primaries depended on HPV status and primary treatment modality. Higher rates of emerging primaries were seen in the dND group (35 %) compared to the IMRT group (6 %), with salvage treatment resulting in cure rates of 78 % and 27 %, respectively. Most regional failures in the IMRT group originated within elective clinical target volumes (89 %). No significant difference in loco-regional failure was observed when comparing the dND group with the IMRT group, when including salvage effects.

Conclusion

The study findings support a personalized treatment strategy guided by HPV status and highlight the importance of including salvage outcomes in treatment efficacy analyses.

查看原文本刊更多论文

原发不明的头颈癌的失败模式与抢救。这是DAHANCA的一项全国性研究。

背景：头颈部未知原发鳞状细胞癌（HNSCCUP）患者的失败模式取决于疾病病因、治疗类型和程度。治疗策略可能包括放射治疗，以解决任何潜在的粘膜肿瘤部位，或者，如果原发肿瘤随后出现，则省略粘膜照射以允许靶向干预。丹麦2013年指南采用了基于n-分类和eb病毒状态的两种策略，但不包括人类乳头瘤病毒（HPV）状态。本研究旨在分析一个完整的，全国范围的丹麦HNSCCUP患者队列的失败模式，重点是HPV状态，治疗目标和挽救结果。材料与方法：所有2014年至2020年期间接受治疗的HNSCCUP患者均在DAHANCA数据库中检索。一种基于图像的失败分析模式被用于评估复发部位的初级治疗覆盖范围。结果：在254例HNSCCUP患者的连续队列中，43% %患有hpv相关疾病（p16阳性）。治疗方式包括明确的颈部清扫（dND）（n = 60）和治疗方案包括调强放疗（IMRT, n = 194）；术后或原发性IMRT伴或不伴辅助化疗。71例患者（28 %）在5 年内出现失败。新发原发的解剖定位取决于HPV状态和原发治疗方式。与IMRT组（6 %）相比，dND组（35 %）的新发原发率更高，挽救治疗的治愈率分别为78 %和27 %。IMRT组的大多数局部失败源于可选的临床靶量（89% %）。当包括挽救效果时，将dND组与IMRT组进行比较时，没有观察到局部区域失败的显着差异。结论：研究结果支持以HPV状态为指导的个性化治疗策略，并强调了在治疗疗效分析中包括挽救结果的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.