Management of human papillomavirus-related unknown primaries of the head and neck with a transoral surgical approach

Abstract

Background: Amidst a rising incidence of p16-positive (p16+) oropharyngeal cancer, a significant number of cases present as regionally metastatic disease with an "unknown" primary. Preliminary data support transoral surgery as an effective method of primary detection/treatment.

Methods: An observational cohort study of 65 p16+ unknown primary patients treated with transoral surgery and neck dissection (2001-2012) was performed. Adjuvant therapy and recurrence data were collected. Kaplan-Meier estimates were computed for disease-specific survival (DSS) and overall survival (OS).

Results: The primary detection rate was 89% (58 of 65). Five-year DSS and OS were 98% and 97% for the detected group and 100% for the undetected, respectively. Seventeen patients were treated with surgery alone. Of the 47 patients receiving adjuvant therapy, radiation to the pharynx was spared in 36.

Conclusion: The transoral approach was highly effective for the diagnosis and treatment of the p16+ unknown primary and laid the foundation for deescalated radiation by elimination of the pharyngeal field.

Keywords: human papillomavirus (HPV); p16; transoral laser microsurgery (TLM); transoral robotic surgery (TORS); unknown primary.