Cervical squamous cell carcinoma of unknown primary: Oncological outcomes and prognostic factors

Precision and Pitfalls: A Prospective Study Analysing the Immediate Postoperative Sequelae and Oncological Outcome of TORS When Used in Diagnostic Algorithm of Carcinoma Unknown Primary

With the realm of carcinoma unknown primary, incorporating Trans Oral Robotic Surgery represents the diagnostic frontier. This study emphasises the immediate postoperative sequelae and also oncological outcome of patients who underwent TORS to diagnose the primary site in unknown primary carcinoma and assesses the feasibility in the Indian scenario. A prospective study was carried out at a tertiary care centre over two years (January 2020 to January 2022). Patients underwent TORS-assisted ipsilateral radical tonsillectomy, tongue base mucosal wedge biopsy and neck dissection as a part of the diagnostic algorithm of carcinoma unknown primary. The postoperative complications, need for nasogastric feeding, need for tracheostomy, return to oral diet and duration of hospital stay were assessed in these patients. Oncological outcomes were assessed in the same population with the median follow up duration of 49 months. The study encompassed a group of 18 patients of Carcinoma Unknown Primary (CUP) who underwent a comprehensive set of procedures, including ipsilateral radical tonsillectomy, mucosal tongue base wedge biopsy, and neck dissection for the identification of the primary site. The average duration of inpatient stay post-surgical procedure was 3.33 ± 0.57 days. A late postoperative complication of Transoral Robotic Surgery (TORS) manifested as minor intraoral bleeding in 11.1% of patients (n = 2/18). An immediate postoperative complication related to neck dissection, specifically neck hematoma, occurred in 11.76% of patients (n = 2/17). Tracheostomy and nasogastric feeds were implemented for a short period in only 5.9% of patients (n = 1/17). Survival analysis conducted on the same population, with a median follow-up of 33 months, revealed no differences in Overall Survival (OS) and Disease-Free Survival (DFS) concerning primary site identification and HPV positivity. Transoral Robotic Surgery (TORS) with concurrent neck dissection proves to be an effective diagnostic and concurrent treatment option for patients with Carcinoma of unknown primary (CUP) with secondary squamous cell neck metastasis. This minimally invasive approach shows a 3-year overall survival rate of 88.69% and a disease-free survival rate of 89.12% with median follow up duration of 33 months.

[Diagnosis, treatment and oncological outcome of cervical CUP-syndrome depending on p16 status]

The incidence of cervical squamous cell carcinoma (SCC)-CUP is increasing, with a significant proportion being HPV-associated. In this 10-year retrospective study, we analyzed clinical and therapeutic parameters of patients with cervical SCC-CUP. Primary tumor detection rates in patients with initial SCC-CUP (SCC-CUPinit) were assessed and mean overall survival and disease-free survival of patients without primary tumor detection after an extended diagnostic workup, i.e. definitive SCC-CUP (SCC-CUPdef), were analyzed taking p16-status into account to derive therapeutic recommendations.85% (n=131/155) of patients with CUPinit, presented with SCC followed by adenocarcinoma metastases in 7% (n=10/155). In 41% (n=54/131) of patients with SCC-CUPinit, a primary tumor was identified after an extended diagnostic workup; the primary tumor detection rate was significantly higher in p16-positive compared to p16-negative cases (63% vs. 23%, p<0,001). PET imaging specificity was 73% for both sensitivity and specificity. SCC-CUPdef were primarily treated surgically with adjuvant radio(chemo)therapy. SCC-CUPdef patients with positive vs. negative p16-status had significantly longer overall survival (53 vs. 41 Monate, p=0,037), as well as patients with cN1- vs. cN3-status and M0- vs. M1-status.p16-status influences diagnosis and therapy response in patients with SCC-CUP: in p16-positive SCC-CUPinit, primary tumor detection rates were significantly higher than in p16-negative SCC-CUPinit. In patients with SCC-CUPdef, p16-positivity was associated with improved overall survival, albeit to an extent which does not justify therapy de-escalation.

Trans oral robotic surgery for oropharyngeal cancer: A multi institutional experience

OBJECTIVES

Trans Oral Robotic Surgery (TORS) has proved to be a safe and feasible treatment for oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to analyse oncological outcomes of OPSCC patients treated with TORS.

MATERIALS AND METHODS

This study involved 139 patients with OPSCC, treated with TORS between 2008 and 2020. Clinicopathological characteristics, treatment details and oncological outcomes were evaluated retrospectively.

RESULTS

The management strategies included TORS alone in 42.5%, TORS-RT in 25.2% and TORS-CRT in 30.9%. The ENE was noted in 28.8% of neck dissections. In 19 patients clinically classified as unknown primaries, the primary was found in 73.7%. Rates of local, regional relapses and distant metastasis were 8.6%, 7.2%, and 6.5%, respectively. The 5 year- Overall Survival and Disease Free Survival were 69.6% and 71.3%, respectively.

CONCLUSION

TORS fits well in the modern management of OPSCC. Although definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of the therapeutic strategy requires evaluation by a multidisciplinary team.