Management of head and neck cancer of unknown primary: A phase IV study by DAHANCA

Signe Bergliot Nielsen; Nina Munk Lyhne; Maria Andersen; Christina Caroline Plaschke; Anita Birgitte Gothelf; Jørgen Johansen; Christian Maare; Mohammad Farhadi; Christian Godballe; Hanne Primdahl; Anne Ivalu Sander Holm; Jan Alsner; Thomas Kjærgaard; Jens Overgaard

doi:10.1016/j.ejca.2024.115211

Management of head and neck cancer of unknown primary: A phase IV study by DAHANCA

Signe Bergliot Nielsen, Nina Munk Lyhne, Maria Andersen, Christina Caroline Plaschke, Anita Birgitte Gothelf, Jørgen Johansen, Christian Maare, Mohammad Farhadi, Christian Godballe, Hanne Primdahl, Anne Ivalu Sander Holm, Jan Alsner, Thomas Kjærgaard, Jens Overgaard

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

BACKGROUND: Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients.

MATERIALS AND METHODS: Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3.

RESULTS: A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 95 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively.

CONCLUSION: The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome.

Original language	English
Article number	115211
Journal	European Journal of Cancer
Volume	216
ISSN	0959-8049
DOIs	https://doi.org/10.1016/j.ejca.2024.115211
Publication status	Published - 5 Feb 2025

Keywords

Chemoradiotherapy
Guideline Adherence
Head and Neck Neoplasms
Neck Dissection
Papillomavirus Infections
Positron Emission Tomography Computed Tomography
Squamous Cell Carcinoma of Head and Neck
Surgical Diagnostic Techniques
Treatment Outcome
Unknown Primary Neoplasms

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Nielsen, S. B., Lyhne, N. M., Andersen, M., Plaschke, C. C., Gothelf, A. B., Johansen, J., Maare, C., Farhadi, M., Godballe, C., Primdahl, H., Holm, A. I. S., Alsner, J., Kjærgaard, T., & Overgaard, J. (2025). Management of head and neck cancer of unknown primary: A phase IV study by DAHANCA. European Journal of Cancer, 216, Article 115211. https://doi.org/10.1016/j.ejca.2024.115211

@article{64e6a7f8934141de8d2452376faed71c,

title = "Management of head and neck cancer of unknown primary: A phase IV study by DAHANCA",

abstract = "BACKGROUND: Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients.MATERIALS AND METHODS: Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3.RESULTS: A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 95 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively.CONCLUSION: The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome.",

keywords = "Chemoradiotherapy, Guideline Adherence, Head and Neck Neoplasms, Neck Dissection, Papillomavirus Infections, Positron Emission Tomography Computed Tomography, Squamous Cell Carcinoma of Head and Neck, Surgical Diagnostic Techniques, Treatment Outcome, Unknown Primary Neoplasms",

author = "Nielsen, {Signe Bergliot} and Lyhne, {Nina Munk} and Maria Andersen and Plaschke, {Christina Caroline} and Gothelf, {Anita Birgitte} and J{\o}rgen Johansen and Christian Maare and Mohammad Farhadi and Christian Godballe and Hanne Primdahl and Holm, {Anne Ivalu Sander} and Jan Alsner and Thomas Kj{\ae}rgaard and Jens Overgaard",

year = "2025",

month = feb,

day = "5",

doi = "10.1016/j.ejca.2024.115211",

language = "English",

volume = "216",

journal = "European Journal of Cancer",

issn = "0959-8049",

publisher = "Elsevier Ltd",

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TY - JOUR

T1 - Management of head and neck cancer of unknown primary

T2 - A phase IV study by DAHANCA

AU - Nielsen, Signe Bergliot

AU - Lyhne, Nina Munk

AU - Andersen, Maria

AU - Plaschke, Christina Caroline

AU - Gothelf, Anita Birgitte

AU - Johansen, Jørgen

AU - Maare, Christian

AU - Farhadi, Mohammad

AU - Godballe, Christian

AU - Primdahl, Hanne

AU - Holm, Anne Ivalu Sander

AU - Alsner, Jan

AU - Kjærgaard, Thomas

AU - Overgaard, Jens

PY - 2025/2/5

Y1 - 2025/2/5

N2 - BACKGROUND: Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients.MATERIALS AND METHODS: Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3.RESULTS: A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 95 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively.CONCLUSION: The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome.

AB - BACKGROUND: Diagnostic and therapeutic management of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remains a challenge. The aim of the present phase IV study was to assess adherence to the current Danish guidelines and evaluate the treatment outcome in HNSCCUP patients.MATERIALS AND METHODS: Prospectively collected data in the DAHANCA database from patients treated between 2014 and 2020 was evaluated. The median follow-up was 6.7 years. Treatment included definitive neck dissection (dND), primary (chemo-)radiotherapy ((C-)RT), neck dissection (ND) followed by postoperative (C-)RT (ND + (C-)PORT). Outcome were reported as five-year estimates of loco-regional failure (LRF), ultimate LRF (ULRF), disease specific mortality (DSM), overall survival (OS), and toxicity scores ≥ 3.RESULTS: A total of 288 patients were treated, of which 254 (88 %) received treatment with curative intent and were eligible for adherence assessment. These were allocated to dND (n = 60), (C-)RT (n = 81) and ND + (C-)PORT (n = 113). The HPV/p16 status was known in 95 % of patients with 109 (43 %) positive cases. The 5-year LRF, DSM, and OS for patients treated with curative intent was 22 %, 15 % and 73 %, and in patients with p16 positive disease 16 %, 5 %, and 85 %. The overall guideline adherence was 76 % (192/254). In the adherent group the LRF, ULRF, DSM, and OS were 22 %, 11 %, 16 %, and 73 %, respectively.CONCLUSION: The study revealed good treatment outcome measures in HNSCCUP patients subject to the Danish guidelines, comparable to other head and neck cancer patients. The observed guideline-deviations did not affect outcome.

KW - Chemoradiotherapy

KW - Guideline Adherence

KW - Head and Neck Neoplasms

KW - Neck Dissection

KW - Papillomavirus Infections

KW - Positron Emission Tomography Computed Tomography

KW - Squamous Cell Carcinoma of Head and Neck

KW - Surgical Diagnostic Techniques

KW - Treatment Outcome

KW - Unknown Primary Neoplasms

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U2 - 10.1016/j.ejca.2024.115211

DO - 10.1016/j.ejca.2024.115211

M3 - Journal article

C2 - 39753047

SN - 0959-8049

VL - 216

JO - European Journal of Cancer

JF - European Journal of Cancer

M1 - 115211

ER -

Management of head and neck cancer of unknown primary: A phase IV study by DAHANCA

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