Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)

Abstract Introduction In contrast to head and neck squamous cell carcinoma (HNSCC), the effect of treatment duration in HNSCC-CUP has not been thoroughly investigated. Thus, this study aimed to assess the impact of the time interval between surgery and adjuvant therapy on the oncologic outcome, in p...

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Autores principales:	Matthias Balk, Robin Rupp, Konstantin Mantsopoulos, Moritz Allner, Philipp Grundtner, SK Mueller, Maximilian Traxdorf, Markus Eckstein, Stefan Speer, Sabine Semrau, Rainer Fietkau, Heinrich Iro, Markus Hecht, Antoniu-Oreste Gostian
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	CUP-syndrome Delayed adjuvant therapy Advanced head and neck cancer Neck dissection Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/d2f6e94ca3134e68aabee7c554217136
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spelling	oai:doaj.org-article:d2f6e94ca3134e68aabee7c5542171362021-11-21T12:30:11ZRelevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)10.1186/s12885-021-08885-31471-2407https://doaj.org/article/d2f6e94ca3134e68aabee7c5542171362021-11-01T00:00:00Zhttps://doi.org/10.1186/s12885-021-08885-3https://doaj.org/toc/1471-2407Abstract Introduction In contrast to head and neck squamous cell carcinoma (HNSCC), the effect of treatment duration in HNSCC-CUP has not been thoroughly investigated. Thus, this study aimed to assess the impact of the time interval between surgery and adjuvant therapy on the oncologic outcome, in particular the 5-year overall survival rate (OS), in advanced stage, HPV-negative CUPs at a tertiary referral hospital. 5-year disease specific survival rate (DSS) and progression free survival rate (PFS) are defined as secondary objectives. Material and methods Between January 1st, 2007, and March 31st, 2020 a total of 131 patients with CUP were treated. Out of these, 59 patients with a confirmed negative p16 analysis were referred to a so-called CUP-panendoscopy with simultaneous unilateral neck dissection followed by adjuvant therapy. The cut-off between tumor removal and delivery of adjuvant therapy was set at the median, i.e. patients receiving adjuvant therapy below or above the median time interval. Results Depending on the median time interval of 55 days (d) (95% CI 51.42–84.52), 30 patients received adjuvant therapy within 55 d (mean 41.69 d, SD = 9.03) after surgery in contrast to 29 patients at least after 55 d (mean 73.21 d, SD = 19.16). All patients involved in the study were diagnosed in advanced tumor stages UICC III (n = 4; 6.8%), IVA (n = 27; 45.8%) and IVB (n = 28; 47.5%). Every patient was treated with curative neck dissection. Adjuvant chemo (immune) radiation was performed in 55 patients (93.2%), 4 patients (6.8%) underwent adjuvant radiation only. The mean follow-up time was 43.6 months (SD = 36.7 months). The 5-year OS rate for all patients involved was 71% (95% CI 0.55–0.86). For those patients receiving adjuvant therapy within 55 d (77, 95% CI 0.48–1.06) the OS rate was higher, yet not significantly different from those with delayed treatment (64, 95% CI 0.42–0.80; X2 (1) = 1.16, p = 0.281). Regarding all patients, the 5-year DSS rate was 86% (95% CI 0.75–0.96). Patients submitted to adjuvant treatment in less than 55 d the DSS rate was 95% (95% CI 0.89–1.01) compared to patients submitted to adjuvant treatment equal or later than 55 d (76% (95% CI 0.57–0.95; X2 (1) = 2.32, p = 0.128). The 5-year PFS rate of the entire cohort was 72% (95% CI 0.59–0.85). In the group < 55 d the PFS rate was 78% (95% CI 0.63–0.94) and thus not significantly different from 65% (95% CI 0.45–0.85) of the group ≥55 d; (X2 (1) = 0.29, p = 0.589). Conclusions The results presented suggest that the oncologic outcome of patients with advanced, HPV-negative CUP of the head and neck was not significantly affected by a prolonged period between surgery and adjuvant therapy. Nevertheless, oncologic outcome tends to be superior for early adjuvant therapy.Matthias BalkRobin RuppKonstantin MantsopoulosMoritz AllnerPhilipp GrundtnerSK MuellerMaximilian TraxdorfMarkus EcksteinStefan SpeerSabine SemrauRainer FietkauHeinrich IroMarkus HechtAntoniu-Oreste GostianBMCarticleCUP-syndromeDelayed adjuvant therapyAdvanced head and neck cancerNeck dissectionNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBMC Cancer, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	CUP-syndrome Delayed adjuvant therapy Advanced head and neck cancer Neck dissection Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	CUP-syndrome Delayed adjuvant therapy Advanced head and neck cancer Neck dissection Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Matthias Balk Robin Rupp Konstantin Mantsopoulos Moritz Allner Philipp Grundtner SK Mueller Maximilian Traxdorf Markus Eckstein Stefan Speer Sabine Semrau Rainer Fietkau Heinrich Iro Markus Hecht Antoniu-Oreste Gostian Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)
description	Abstract Introduction In contrast to head and neck squamous cell carcinoma (HNSCC), the effect of treatment duration in HNSCC-CUP has not been thoroughly investigated. Thus, this study aimed to assess the impact of the time interval between surgery and adjuvant therapy on the oncologic outcome, in particular the 5-year overall survival rate (OS), in advanced stage, HPV-negative CUPs at a tertiary referral hospital. 5-year disease specific survival rate (DSS) and progression free survival rate (PFS) are defined as secondary objectives. Material and methods Between January 1st, 2007, and March 31st, 2020 a total of 131 patients with CUP were treated. Out of these, 59 patients with a confirmed negative p16 analysis were referred to a so-called CUP-panendoscopy with simultaneous unilateral neck dissection followed by adjuvant therapy. The cut-off between tumor removal and delivery of adjuvant therapy was set at the median, i.e. patients receiving adjuvant therapy below or above the median time interval. Results Depending on the median time interval of 55 days (d) (95% CI 51.42–84.52), 30 patients received adjuvant therapy within 55 d (mean 41.69 d, SD = 9.03) after surgery in contrast to 29 patients at least after 55 d (mean 73.21 d, SD = 19.16). All patients involved in the study were diagnosed in advanced tumor stages UICC III (n = 4; 6.8%), IVA (n = 27; 45.8%) and IVB (n = 28; 47.5%). Every patient was treated with curative neck dissection. Adjuvant chemo (immune) radiation was performed in 55 patients (93.2%), 4 patients (6.8%) underwent adjuvant radiation only. The mean follow-up time was 43.6 months (SD = 36.7 months). The 5-year OS rate for all patients involved was 71% (95% CI 0.55–0.86). For those patients receiving adjuvant therapy within 55 d (77, 95% CI 0.48–1.06) the OS rate was higher, yet not significantly different from those with delayed treatment (64, 95% CI 0.42–0.80; X2 (1) = 1.16, p = 0.281). Regarding all patients, the 5-year DSS rate was 86% (95% CI 0.75–0.96). Patients submitted to adjuvant treatment in less than 55 d the DSS rate was 95% (95% CI 0.89–1.01) compared to patients submitted to adjuvant treatment equal or later than 55 d (76% (95% CI 0.57–0.95; X2 (1) = 2.32, p = 0.128). The 5-year PFS rate of the entire cohort was 72% (95% CI 0.59–0.85). In the group < 55 d the PFS rate was 78% (95% CI 0.63–0.94) and thus not significantly different from 65% (95% CI 0.45–0.85) of the group ≥55 d; (X2 (1) = 0.29, p = 0.589). Conclusions The results presented suggest that the oncologic outcome of patients with advanced, HPV-negative CUP of the head and neck was not significantly affected by a prolonged period between surgery and adjuvant therapy. Nevertheless, oncologic outcome tends to be superior for early adjuvant therapy.
format	article
author	Matthias Balk Robin Rupp Konstantin Mantsopoulos Moritz Allner Philipp Grundtner SK Mueller Maximilian Traxdorf Markus Eckstein Stefan Speer Sabine Semrau Rainer Fietkau Heinrich Iro Markus Hecht Antoniu-Oreste Gostian
author_facet	Matthias Balk Robin Rupp Konstantin Mantsopoulos Moritz Allner Philipp Grundtner SK Mueller Maximilian Traxdorf Markus Eckstein Stefan Speer Sabine Semrau Rainer Fietkau Heinrich Iro Markus Hecht Antoniu-Oreste Gostian
author_sort	Matthias Balk
title	Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)
title_short	Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)
title_full	Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)
title_fullStr	Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)
title_full_unstemmed	Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)
title_sort	relevance of the time interval between surgery and adjuvant radio (chemo) therapy in hpv-negative and advanced head and neck carcinoma of unknown primary (cup)
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d2f6e94ca3134e68aabee7c554217136
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Relevance of the time interval between surgery and adjuvant radio (chemo) therapy in HPV-negative and advanced head and neck carcinoma of unknown primary (CUP)

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