KEY POINTS
- This retrospective two-centre study included 134 patients with head and neck carcinoma of unknown primary: 88 received nodal irradiation without elective mucosal coverage, while 46 also received 50 Gy pan-mucosal irradiation.
- Treatment consisted of neck dissection followed by adjuvant radiotherapy or chemoradiotherapy, or definitive radiotherapy or chemoradiotherapy for patients without surgery or with advanced nodal disease. Median follow-up was 72 months.
- Five-year overall survival was 57.5% with nodal-only irradiation and 56.1% with additional pan-mucosal irradiation, with no significant difference between centres (P = .899).
- Recurrence occurred in 24 of 88 patients (27.3%) without pan-mucosal irradiation and 15 of 46 (32.6%) with pan-mucosal irradiation (P = .519). Disease-free survival also did not differ significantly (P = .724).
- Mucosal recurrence occurred in 9 versus 4 patients (P = .282). All 13 events developed more than 36 months after diagnosis and exclusively in persistent smokers.
CLINICAL TAKEAWAY
After comprehensive diagnostic evaluation, routinely adding pan-mucosal irradiation to nodal treatment may not provide an oncologic advantage for every patient with head and neck carcinoma of unknown primary. However, the comparison was retrospective and nonrandomized, with institutional differences, evolving techniques, and no detailed dosimetric or toxicity analysis, making the result worth attention rather than practice-changing.