Robotic Surgery for Primary Head and Neck Squamous Cell Carcinoma of Unknown Site | Head and Neck Cancer | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.186.91. Please contact the publisher to request reinstatement.
1.
Jereczek-Fossa  BA, Jassem  J, Orecchia  R.  Cervical lymph node metastases of squamous cell carcinoma from an unknown primary.  Cancer Treat Rev. 2004;30(2):153-164.PubMedGoogle ScholarCrossref
2.
Cianchetti  M, Mancuso  AA, Amdur  RJ,  et al.  Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.  Laryngoscope. 2009;119(12):2348-2354.PubMedGoogle ScholarCrossref
3.
Iganej  S, Kagan  R, Anderson  P,  et al.  Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse.  Head Neck. 2002;24(3):236-246.PubMedGoogle ScholarCrossref
4.
Mendenhall  WM, Mancuso  AA, Parsons  JT, Stringer  SP, Cassisi  NJ.  Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.  Head Neck. 1998;20(8):739-744.PubMedGoogle ScholarCrossref
5.
Martin  H, Morfit  HM.  Cervical lymph node metastasis as the first symptom of cancer.  Surg Gynecol Obstet. 1944;78:133-159.Google Scholar
6.
Haas  I, Hoffmann  TK, Engers  R, Ganzer  U.  Diagnostic strategies in cervical carcinoma of an unknown primary (CUP).  Eur Arch Otorhinolaryngol. 2002;259(6):325-333.PubMedGoogle Scholar
7.
Braams  JW, Pruim  J, Kole  AC,  et al.  Detection of unknown primary head and neck tumors by positron emission tomography.  Int J Oral Maxillofac Surg. 1997;26(2):112-115.PubMedGoogle ScholarCrossref
8.
Lassen  U, Daugaard  G, Eigtved  A, Damgaard  K, Friberg  L.  18F-FDG whole body positron emission tomography (PET) in patients with unknown primary tumours (UPT).  Eur J Cancer. 1999;35(7):1076-1082.PubMedGoogle ScholarCrossref
9.
Safa  AA, Tran  LM, Rege  S,  et al The role of positron emission tomography in occult primary head and neck cancers.  Cancer J Sci Am.1999;5(4):214-218.PubMedGoogle Scholar
10.
Regelink  G, Brouwer  J, de Bree  R,  et al.  Detection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities.  Eur J Nucl Med Mol Imaging. 2002;29(8):1024-1030.PubMedGoogle ScholarCrossref
11.
Fletcher  JW, Djulbegovic  B, Soares  HP,  et al.  Recommendations on the use of 18F-FDG PET in oncology.  J Nucl Med. 2008;49(3):480-508.PubMedGoogle ScholarCrossref
12.
Miller  FR, Hussey  D, Beeram  M, Eng  T, McGuff  HS, Otto  RA.  Positron emission tomography in the management of unknown primary head and neck carcinoma.  Arch Otolaryngol Head Neck Surg. 2005;131(7):626-629.PubMedGoogle ScholarCrossref
13.
Pattani  KM, Goodier  M, Lilien  D, Kupferman  T, Caldito  G, Nathan  CO.  Utility of panendoscopy for the detection of unknown primary head and neck cancer in patients with a negative PET/CT scan.  Ear Nose Throat J. 2011;90(8):E16-E20.PubMedGoogle Scholar
14.
Holsinger  FC, Sweeney  AD, Jantharapattana  K,  et al.  The emergence of endoscopic head and neck surgery.  Curr Oncol Rep. 2010;12(3):216-222.PubMedGoogle ScholarCrossref
15.
Karni  RJ, Rich  JT, Sinha  P, Haughey  BH.  Transoral laser microsurgery: a new approach for unknown primaries of the head and neck.  Laryngoscope. 2011;121(6):1194-1201.PubMedGoogle ScholarCrossref
16.
Oen  AL, de Boer  MF, Hop  WC, Knegt  P.  Cervical metastasis from the unknown primary tumor.  Eur Arch Otorhinolaryngol. 1995;252(4):222-228.PubMedGoogle ScholarCrossref
17.
Koivunen  P, Laranne  J, Virtaniemi  J,  et al.  Cervical metastasis of unknown origin: a series of 72 patients.  Acta Otolaryngol. 2002;122(5):569-574.PubMedGoogle ScholarCrossref
18.
Koch  WM, Bhatti  N, Williams  MF, Eisele  DW.  Oncologic rationale for bilateral tonsillectomy in head and neck squamous cell carcinoma of unknown primary source.  Otolaryngol Head Neck Surg. 2001;124(3):331-333.PubMedGoogle ScholarCrossref
19.
Lindberg  R.  Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts.  Cancer. 1972;29(6):1446-1449.PubMedGoogle ScholarCrossref
20.
McQuone  SJ, Eisele  DW, Lee  DJ, Westra  WH, Koch  WM.  Occult tonsillar carcinoma in the unknown primary.  Laryngoscope. 1998;108(11, pt 1):1605-1610.PubMedGoogle ScholarCrossref
21.
Mendenhall  WM, Mancuso  AA, Amdur  RJ, Stringer  SP, Villaret  DB, Cassisi  NJ.  Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site  . Am J Otolaryngol.2001;22(4):261-267.PubMedGoogle Scholar
22.
Wong  WL, Sonoda  LI, Gharpurhy  A,  et al.  18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers: an audit and review of published studies.  Clin Oncol (R Coll Radiol). 2012;24(3):190-195.PubMedGoogle ScholarCrossref
23.
Silva  P, Hulse  P, Sykes  AJ,  et al.  Should FDG-PET scanning be routinely used for patients with an unknown head and neck squamous primary?  J Laryngol Otol. 2007;121(2):149-153.PubMedGoogle ScholarCrossref
24.
Padovani  D, Aimoni  C, Zucchetta  P, Paluzzi  A, Pastore  A.  18-FDG PET in the diagnosis of laterocervical metastases from occult carcinoma.  Eur Arch Otorhinolaryngol. 2009;266(2):267-271.PubMedGoogle ScholarCrossref
25.
Wartski  M, Le Stanc  E, Gontier  E,  et al.  In search of an unknown primary tumour presenting with cervical metastases: performance of hybrid FDG-PET-CT.  Nucl Med Commun. 2007;28(5):365-371.PubMedGoogle ScholarCrossref
26.
Mehta  V, Johnson  P, Tassler  A,  et al.  A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery.  Laryngoscope. 2013;123(1):146-151.PubMedGoogle ScholarCrossref
27.
Muraki  AS, Mancuso  AA, Harnsberger  HR.  Metastatic cervical adenopathy from tumors of unknown origin: the role of CT.  Radiology. 1984;152(3):749-753.PubMedGoogle Scholar
28.
Hermans  R. Imaging in cervical nodal metastases of unknown primary.  Cancer Imaging.2011;11(spec No. A):S9-S14.Google ScholarCrossref
29.
de Braud  F, al-Sarraf  M.  Diagnosis and management of squamous cell carcinoma of unknown primary tumor site of the neck.  Semin Oncol. 1993;20(3):273-278.PubMedGoogle Scholar
30.
Schmalbach  CE, Miller  FR.  Occult primary head and neck carcinoma.  Curr Oncol Rep. 2007;9(2):139-146.PubMedGoogle ScholarCrossref
31.
Boudreaux  BA, Rosenthal  EL, Magnuson  JS,  et al.  Robot-assisted surgery for upper aerodigestive tract neoplasms.  Arch Otolaryngol Head Neck Surg. 2009;135(4):397-401.PubMedGoogle ScholarCrossref
32.
Vergez  S, Lallemant  B, Ceruse  P,  et al.  Initial multi-institutional experience with transoral robotic surgery.  Otolaryngol Head Neck Surg. 2012;147(3):475-481.PubMedGoogle ScholarCrossref
33.
Hans  S, Badoual  C, Gorphe  P, Brasnu  D.  Transoral robotic surgery for head and neck carcinomas.  Eur Arch Otorhinolaryngol. 2012;269(8):1979-1984.PubMedGoogle ScholarCrossref
34.
Genden  EM, Desai  S, Sung  CK.  Transoral robotic surgery for the management of head and neck cancer: a preliminary experience.  Head Neck. 2009;31(3):283-289.PubMedGoogle ScholarCrossref
35.
Moore  EJ, Olsen  KD, Kasperbauer  JL.  Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes.  Laryngoscope. 2009;119(11):2156-2164.PubMedGoogle ScholarCrossref
36.
Hurtuk  A, Agrawal  A, Old  M, Teknos  TN, Ozer  E.  Outcomes of transoral robotic surgery: a preliminary clinical experience.  Otolaryngol Head Neck Surg. 2011;145(2):248-253.PubMedGoogle ScholarCrossref
37.
O’Malley  BW  Jr, Weinstein  GS, Snyder  W, Hockstein  NG.  Transoral robotic surgery (TORS) for base of tongue neoplasms.  Laryngoscope. 2006;116(8):1465-1472.PubMedGoogle ScholarCrossref
38.
Weinstein  GS, O’Malley  BW  Jr, Snyder  W, Sherman  E, Quon  H.  Transoral robotic surgery: radical tonsillectomy.  Arch Otolaryngol Head Neck Surg. 2007;133(12):1220-1226.PubMedGoogle ScholarCrossref
39.
Moore  EJ, Olsen  SM, Laborde  RR,  et al.  Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma.  Mayo Clin Proc. 2012;87(3):219-225.PubMedGoogle ScholarCrossref
40.
Sinclair  CF, McColloch  NL, Carroll  WR, Rosenthal  EL, Desmond  RA, Magnuson  JS.  Patient-perceived and objective functional outcomes following transoral robotic surgery for early oropharyngeal carcinoma.  Arch Otolaryngol Head Neck Surg. 2011;137(11):1112-1116.PubMedGoogle ScholarCrossref
41.
Weinstein  GS, O’Malley  BW  Jr, Magnuson  JS,  et al.  Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins.  Laryngoscope. 2012;122(8):1701-1707.PubMedGoogle ScholarCrossref
Original Investigation
November 2013

Robotic Surgery for Primary Head and Neck Squamous Cell Carcinoma of Unknown Site

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
  • 2Department of Otolaryngology, University of Alabama–Birmingham Hospital, Birmingham
  • 3Celebration Health Hospital, Kissimmee, Florida
  • 4Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
  • 5Department of Otorhinolaryngology–Head & Neck Surgery, The University of Texas Health Science Center at Houston, Houston
  • 6Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
  • 7Department of Otolaryngology–Head & Neck Surgery, Oregon Health Sciences University, Portland
  • 8University of Alabama–Birmingham Medical School, Birmingham
  • 9Baylor College of Medicine, Houston, Texas
  • 10Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 11Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1203-1211. doi:10.1001/jamaoto.2013.5189
Abstract

Importance  Identification of the primary site in head and neck squamous cell carcinoma (HNSCC) is crucial because it improves the patient’s prognosis and minimizes morbidity from treatment.

Objectives  To determine the efficacy of transoral robotic surgery (TORS) in identifying unknown primary sites of head and neck squamous cell carcinoma.

Design, Setting, and Participants  Retrospective, multi-institutional case series from January 1, 2010, to February 28, 2013, in which data were pooled from the following 6 institutions: University of Washington Medical Center, The University of Texas MD Anderson Cancer Center, University of Alabama–Birmingham Hospital, The University of Texas Medical School at Houston, Johns Hopkins Hospital, and Oregon Health Sciences University. All patients diagnosed as having HNSCC of an unknown primary site who underwent TORS to identify the primary site were included in the study. We excluded those with recurrent disease, a history of radiation therapy to the head and neck, or evidence of a primary tumor site based on previous biopsy results.

Main Outcome and Measure  Identification of the primary tumor site.

Results  Forty-seven patients were eligible for the study. The tumor site was identified by TORS in 34 of 47 patients (72.3%). The primary site was located in the base of tongue for 20 patients (58.8%) and the palatine tonsil for 13 patients (38.2%), with 1 patient having a primary site in both the base of tongue and the palatine tonsil. Suspicious physical examination findings were present in 23 of 47 patients (48.9%), with positive and negative predictive values of 56.5% and 25.0%, respectively. Of those who underwent any imaging, 16 patients had suspicious findings, with positive and negative predictive values of 50.0% and 16.7%, respectively. In 18 of 47 patients (38.3%), both preoperative radiographic and physical examination failed to suggest a primary site. Of these 18 patients, 13 (72.2%) were identified after undergoing TORS.

Conclusions and Relevance  We demonstrate that TORS is a useful approach to identify and treat the primary site in patients with HNSCC who present with an unknown primary site.

×