Summary
This review has highlighted the paucity of evidence relevant to
contemporary practice for HNSCCUP. The studies identified are
heterogenous and span a timeframe from 1969-2018 during which
oncogenesis and diagnostic strategies have evolved considerably,
limiting interpretability of the findings. Crude interpretation of the
data may suggest ND alone is a reasonable treatment consideration for
select patients with p16 positive N1 (TNM7) disease without ECS. For
patients with p16 negative disease the potential primary site is more
varied, and outcomes were inferior with ND alone, given the high rates
of primary emergence. For p16 negative patients it is likely that
multi-modality treatment is nearly always indicated for optimal survival
outcomes.
Whilst a prospective randomised control trial would prove highly
valuable in further defining optimal management strategies, given the
rarity and heterogeneity of this disease entity, patient accrual is
likely to be a significant barrier. Multi centre studies examining
treatment outcomes in a contemporary era of practice may be more
informative. Given the recent updates to AJCC/UICC TNM8 guidelines where
p16 positive HNSCCUP is to be treated along oropharynx paradigms;
extrapolation from relevant studies may be appropriate. For example,
recent randomised control trial data from ECOG 3311(6) report a 2-yr PFS
of 96.9% for a group of patients with T1-2, N0-1 (TNM 7) oropharynx
cancer treated with surgery alone (27/38 patients N1 disease, no ECS)