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
{"title":"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。","authors":"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","doi":"10.1016/j.radonc.2025.111162","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Materials & Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>The study findings support a personalized treatment strategy guided by HPV status and highlight the importance of including salvage outcomes in treatment efficacy analyses.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111162"},"PeriodicalIF":5.3000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Failure pattern and salvage in head and neck cancer of unknown primary: A national study by DAHANCA\",\"authors\":\"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\",\"doi\":\"10.1016/j.radonc.2025.111162\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Materials & Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>The study findings support a personalized treatment strategy guided by HPV status and highlight the importance of including salvage outcomes in treatment efficacy analyses.</div></div>\",\"PeriodicalId\":21041,\"journal\":{\"name\":\"Radiotherapy and Oncology\",\"volume\":\"213 \",\"pages\":\"Article 111162\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiotherapy and Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0167814025051667\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0167814025051667","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Failure pattern and salvage in head and neck cancer of unknown primary: A national study by DAHANCA
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.
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.