Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Management strategies for head and neck squamous cell carcinoma of unknown primary (HNSCCUP) remain highly variable. Care of HNSCCUP patients requires multidisciplinary coordination and nuanced decision making, with a goal of excellent oncologic control and maintenance of swallowing function. Here, we report the impact of implementation of a standardized algorithm for the workup and treatment of patients with HNSCCUP.
Methods: We performed a retrospective, single-institution cohort study of patients with HNSCCUP treated with curative intent before and after implementation of a standardized algorithm in 2022. HNSCCUP was defined as biopsy-confirmed squamous cell carcinoma in a cervical lymph node with no evidence of primary on physical exam or imaging workup including PET/CT. The primary outcome measure, primary site identification rate, was compared descriptively. HNSCCUP patients enrolled in a prospective registry were cross-referenced for functional outcome measures, including MDADI and DIGEST scores. A comparison of treatment methods and functional outcome measures before and after implementation of the algorithm was performed.
Results: We identified 139 patients treated for HNSCCUP at our institution from 2014-2023. 107 (77%) patients were treated before and 32 (23%) after implementation of the HNSCCUP algorithm. The primary site identification rate before implementation was 60% compared to 91% after implementation (p=0.001). The proportion of HNSCCUP patients treated with primary curative intent surgery, with or without adjuvant therapy, increased from 22% to 53% (p=0.001). Detailed oncologic and functional outcomes of this cohort will be presented.
Conclusions: Implementation of a standarized algorithm significantly increased the primary site identification rate for HNSCCUP and was associated with an increased utilization of primary surgery. Functional outcomes for this cohort will be important for understanding the potential benefit of improved primary site identification.