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Video

Head and Neck Surgery

(A574) Management and Outcomes of Head and Neck Cancer of Unknown Primary: Our Institutional Experience

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • BB

    Bailey Balouch, MD

    Resident
    Cooper Medical School of Rowan University
    Philadelphia, Pennsylvania, United States

    • Senior Author(s)

  • BS

    Brian Swendseid, MD

    Assistant Professor of Surgery, Cooper Medical School of Rowan University
    Cooper Health System, MD Anderson Cancer Center at Cooper
    Camden, New Jersey, United States

Disclosure(s):
Brian Swendseid, MD: No relevant relationships to disclose.


Introduction: Our objective was to describe the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) when the primary site was never identified, and to compare outcomes based on treatment delivered.

Methods: This was a retrospective series of 33 patients who presented to our cancer center between 1/2014 and 1/2024 with biopsy-proven HNSCCUP who failed to have a primary site identified after comprehensive workup. Outcomes included overall survival (OS), disease-free survival (DFS), and recurrence rate, and were compared between treatment modalities delivered.

Results: Treatment included definitive surgery (63.6%), radiation (81.8%), and/or chemotherapy (54.5%) with curative intent. Surgical management included neck dissection (48.5%), tonsillectomy (45.5%), and/or base of tongue (BOT) resection (54.5%). Ipsilateral tonsillectomy was associated with a significant reduction in radiation dose delivered to the neck and oropharyngeal subsites. Ipsilateral BOT resection was associated with significantly greater DFS (94.4% versus 53.3%). Neck dissection allowed for significantly lower radiation dose delivered to the neck and reduced need for systemic chemotherapy. When patients were stratified by adjuvant therapy received, OS did not differ significantly between observation (100.0%), radiation (90.0%), or chemoradiation (94.1%). Similarly, DFS did not differ significantly between observation (100.0%), radiation (70.0%), or chemoradiation (70.6%). 21.2% had recurrence, with just one patient (3.0%) having local recurrence with identification of the primary site at that time.

Conclusions: Resection of oropharyngeal subsites may be beneficial in HNSCCUP as these sites could harbor occult malignancy. Tonsillectomy was associated with a reduction in radiation dose delivered to the oropharynx and neck without compromising oncologic outcome, and BOT resection was associated with improved DFS. Observation following oropharyngeal subsite resection was not associated with worse oncologic outcomes when compared to patients who received adjuvant radiation and/or chemotherapy.