A Nordic survey on the management of head and neck CUP

Abstract

Conclusion: The management of Head and Neck Cancer of Unknown Primary (HNCUP) patients varies both between centres within and also between the Nordic countries. This study contributes to a continuing discussion of how to improve the accuracy of diagnosis and quality of treatment of HNCUP patients.

Objectives: The initiative for this study was based on the lack of common guidelines for diagnostic procedures and for treatment of HNCUP patients in the Nordic countries constituting a region having a rather homogeneous population.

Method: A structured questionnaire was sent to all university hospitals in the five Nordic countries.

Results: Four of the five Nordic countries use either national guidelines or specific protocols when handling HNCUP. The main diagnostic tools are PET-CT, fine needle aspiration, endoscopic evaluation with biopsies, and most often bilateral tonsillectomy. At 21 of 22 university hospitals the treatment decision is made at a multidisciplinary conference. Three of seven Swedish centres use only radiotherapy or chemoradiotherapy to treat N+ HNCUP patients. Robotic surgery for biopsy of the tongue base is beginning to become an alternative to targeted biopsies in Sweden and Finland. Narrow Band Imaging is used only in Finland.

Keywords:

• Cancer of unknown origin
• follow up
• multidisciplinary tumour board meeting
• PET-CT

Acknowledgements

We gratefully acknowledge all colleagues in the Nordic countries who have contributed to the data collection: Iceland: Arnar Gudjonson; Norway: Jan Folkvard Evensen, Odd Monge, Åsa Karlsdottir, Marianne Brydoy, Hanne Tondel, John Sigurd Lybeck, and Oddveig Rikardsen; Denmark: Kenneth Jensen; Sweden: Johan Wennerberg, Eva Brun, Magnus Niklasson, Hedda Haugen, Maciej Tytor, Måns Agrup, Jan Rzepecki, Anders Westerborn, Johan Reizenstein, Anders Högmo, Helena Sjödin, Tomas Ekberg, Lena Cederblad, Magnus Wahlgren, and Karin Söderström; and Finland: Leif Bäck, Kauko Saarilahti, Jaakko Pulkkinen, Ilpo Kinnunen, Paula Lindholm, Reidar Grénman, Heikki Minn, Jussi Laranne, Tuija Wigren, Matti Pukkila, Leena Voutilainen, Petri Koivunen, and Merja Korpela. We would also like to acknowledge the Scandinavian Society for Head and Neck Oncology.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.