ASCO GUIDELINES Bundle

Squamous Cell Carcinoma of Unknown Primary Head and Neck

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11 Treatment must be to gross nodal disease, neck regions at-risk of containing microscopic disease and the anatomic mucosal regions at-risk of harboring the occult primary b Definitive chemoradiotherapy Bilateral adenopathy Large volume neck disease Gross (macroscopic) ENE Multidisciplinary discussion Concurrent cisplatin should be offered to patients without contraindications to cisplatin chemotherapy • Suspected mucosal primary HPV/p16-negative squamous cell carcinoma in the presence of unresected AJCC 8th N2-N3 nodal disease • Suspected mucosal primary HPV/p16-negative squamous cell carcinoma in the presence of unresected multiple ipsilateral or bilateral lymph node involvement or lymph nodes >3cm in size • Suspected mucosal primary squamous cell carcinoma and pathologic evidence of ENE • EBER-positive Stage II-IVA (AJCC 8th) carcinoma of unknown primary Patients treated with primary radiotherapy for unilateral involvement of multiple nodes and no clinical and radiologic evidence of ENE should routinely receive bilateral treatment Patients treated with primary radiotherapy for unilateral involvement of a single node and no clinical and radiologic evidence of EN may consider treatment only to the unilateral involved neck (with the exception of those at risk of a nasopharyngeal primary) Patients treated with primary radiotherapy for N3 and/or bilateral nodal involvement and/or clinical and/or radiologic evidence of ENE require bilateral neck treatment Radiotherapy must be to the gross node(s) and with consideration of coverage of putative primary sites in the ipsilateral tonsillar bed, ipsilateral soft palate, and the mucosa of the entire base of tongue, which may be modified based on prior surgical diagnostics at the discretion of the radiation oncologist. c,d Bilateral treatment of the oropharyngeal mucosa Unilateral (AJCC 8th N1) HPV-related adenopathy Unilateral (AJCC 8th N1-N2b) HPV-negative nodal disease Bilateral (AJCC 8th N1-N2c) adenopathy

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