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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 4 - Head and Neck Surgery

Long-Term Outcomes of HPV+ Squamous Cell Carcinoma of Unknown Primary Treated With Transoral Surgery

Sunday, September 29, 2024
1:12 PM – 1:18 PM EDT
Location: MBCC, 208
Disclosure(s):
Thomas F. Barrett, MD, Jr.:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Evan Michael Graboyes, MD, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Richard A. Harbison, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jason T. Rich, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Anthony J. Apicelli, MD, PhD, III:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Wade L. Thorstad, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Sidharth V. Puram, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Ryan S. Jackson, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Management of patients with HPV+ squamous cell carcinoma of unknown primary (UPSCC) remains controversial. Transoral surgery (TOS) with neck dissection (ND) is highly effective in primary lesion detection, minimizing required adjuvant radiation therapy (aRT), and providing excellent oncologic control. However, long-term (> 10 years) survival and functional outcomes have not been reported.

Methods: This is a long-term follow-up of an observational cohort study of patients with HPV+ unknown primary SCC of the head and neck treated with TOS and ND at a single institution between 2001 and 2012 (Graboyes et al, Head and Neck 2014). Demographic, comorbidity, pathologic, adjuvant therapy and follow-up data were collected. Kaplan-Meier estimates were computed for overall (OS) and disease-free (DFS) at 10 years.

Results: There were 64 patients who underwent TOS with ipsilateral (n = 58) or bilateral (n = 6) ND, with primary detection in 57 patients (89.1%). Of these, 47 (73.4%) patients received aRT, 19 (29.7%) of whom received aRT to only the ipsilateral neck. Of patients receiving aRT to the ipsilateral neck, 26 (55.3%) received ≤ 60 Gy. Among those receiving contralateral aRT (n = 28), 27 (96.4%) received ≤ 60 Gy. Mean follow-up time was 10.4 years (median 11.4 years, range 0.2-21.6 years). At most recent follow-up, 60 patients (93.8%) were without evidence of loco-regional or distant metastases. Only 5 patients (7.8%) had second primaries of the head and neck, 3 of which were synchronous lesions. Overall, there were 11 deaths: 2 related to distant metastases of the index cancer, 3 related to head and neck second primary lesions, 2 from cancers of other sites, 2 related to co-morbid conditions, and 2 from unknown causes. Estimated 10-year OS and DFS were 89.7% (95% CI = 81.5%-98.8%) and 92.6% (95% CI = 85.8%-99.9%), respectively. No patients required tracheostomy or G-tube at most recent follow-up.

Conclusions: HPV+ UPSCC patients treated with TOS and ND have excellent 10-year overall and disease-free survival. Deescalating radiation dose to uninvolved sites did not compromise long-term survival.

    Presenting Author(s)

  • Thomas F. Barrett, Jr., MD

    Resident Physician
    Washington University/B-JH/SLCH Consortium
    Saint Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • KE

    Kwasi A. Enin, MD, MBA

    Resident Physician
    Washington University School of Medicine in St. Louis
    St Louis, MO, United States

    Disclosure information not submitted.

  • PP

    Patrik Pipkorn, MD

    Associate professor
    Washington University-BJH/SLCH Consortium, Department of Otolaryngology - Head and Neck Surgery
    St. Louis, MO, United States

    Disclosure information not submitted.

  • Evan Michael Graboyes, MD, MPH

    Associate Professor
    Medical University of South Carolina
    Charleston, South Carolina, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • PZ

    Paul Zolkind, MD

    Washington University School of Medicine in St. Louis, United States

    Disclosure information not submitted.

  • RH

    Richard A. Harbison, MD

    Assistant Professor
    Washington University School of Medicine in St. Louis
    Saint Louis, Missouri, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Jason T. Rich, MD

    Professor
    Washington University School of Medicine in St. Louis
    Saint Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • AA

    Anthony J. Apicelli, III, MD, PhD

    Associate Professor of Radiation Oncology
    Washington University School of Medicine in St. Louis
    Saint Louis, Missouri, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • PO

    Peter Oppelt, MD

    Washington University School of Medicine in St. Louis, United States

    Disclosure information not submitted.

  • HG

    Hiram Gay, MD

    Professor of Radiation Oncology
    Washington University School of Medicine
    Saint Louis, MO, USA

    Disclosure information not submitted.

  • DA

    Douglas Adkins, MD

    Professor
    Washington University School of Medicine in St. Louis, United States

    Disclosure information not submitted.

  • Wade L. Thorstad, MD

    Professor
    Washington University School of Medicine in St. Louis
    St. Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Sidharth V. Puram, MD, PhD

    Chief of Head and Neck Surgery, Director of Rob Ebert and Greg Stubblefield Head and Neck Tumor Center at Siteman, Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • RJ

    Ryan S. Jackson, MD

    Associate Professor
    Washington University School of Medicine
    St. Louis, MO, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.