Volume 134, Issue 2 pp. 701-707
Original Report

Early Improved Functional Outcomes in Head and Neck Cancer Patients with Primary Tumor Detection

Sandhya Kalavacherla BS

Sandhya Kalavacherla BS

School of Medicine, University of California San Diego, La Jolla, California, U.S.A.

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Benjamin Bernard MD

Benjamin Bernard MD

Department of Otolaryngology—Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A.

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Sangwoo S. Kim MD

Sangwoo S. Kim MD

Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, U.S.A.

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Anna Dornisch MD, MAS

Anna Dornisch MD, MAS

Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, U.S.A.

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Liza Blumenfeld MA, CCC-SLP

Liza Blumenfeld MA, CCC-SLP

Department of Otolaryngology—Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A.

Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A.

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Kristen Linnemeyer-Risser MA, CCC-SLP, BCS-S

Kristen Linnemeyer-Risser MA, CCC-SLP, BCS-S

Department of Otolaryngology—Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A.

Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A.

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Parag Sanghvi MD

Parag Sanghvi MD

Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, U.S.A.

Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A.

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Theresa Guo MD

Corresponding Author

Theresa Guo MD

Department of Otolaryngology—Head & Neck Surgery, University of California San Diego, San Diego, California, U.S.A.

Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, California, U.S.A.

Send correspondence to Theresa Guo, Department of Otolaryngology—Head & Neck Surgery, University of California San Diego, 3855 Health Sciences, DrLa Jolla, CA 92037. Email: [email protected]

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First published: 18 July 2023
Citations: 2
Editor's Note: This Manuscript was accepted for publication on July 07, 2023.

2023 Triological Society Combined Sections Meeting, Coronado, CA; January 26–28, 2023.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives

We characterize functional outcomes in head and neck cancer of unknown primary (CUP) based on primary site identification.

Methods

In this retrospective study, CUP cases were categorized as known primaries (KP) if a tumor was localized after diagnostic workup or persisting unknown primaries (UP). Age, sex, HPV status, diagnostic methods, and treatments regimens were collected. Pretreatment and short-term posttreatment (3–6 months after completion of treatment) weights, PHQ-9, Eating Assessment Tool (EAT-10), and Voice Handicap Index (VHI-10) scores were compared between UP and KP.

Results

Among 67 CUP patients, 35 (52.2%) had identified primaries (91.4% oropharyngeal and 8.6% nasopharyngeal). KP patients were younger (58 vs. 64, p = 0.04) and more likely to be HPV-positive (88.6% vs. 50%, p = 0.002). Overall detection rates were 16.7% for PET/CT, 34.7% for direct laryngoscopy, and 46.6% for transoral robotic oropharyngectomy. Diagnostic workup was not significantly different between groups. Patients with KP received smaller intermediate radiation dose volumes (436.5 vs. 278.9 cc, p = 0.03) and lower doses to the cricopharyngeal muscle (41.6 vs. 24.6 Gy, p = 0.03).Pretreatment weights, PHQ-9, EAT-10, and VHI-10 scores did not differ between groups. However, posttreatment, UP had greater relative weight loss (−14.1% vs. −7.6%, p = 0.032), higher EAT-10 scores (12.5 vs. 3, p = 0.004), and higher PHQ-9 scores (6 vs. 1.4, p = 0.017). Specifically, UP reported more stressful swallowing, difficulty swallowing solids and pills, and swallowing affecting public eating.

Conclusion

KP patients experienced less weight loss, depression, and reduced swallowing dysfunction, highlighting an early functional benefit of primary tumor identification likely driven by reduced radiation treatment volumes.

Level of Evidence

4 Laryngoscope, 134:701–707, 2024

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