Evidence map›Paper›PMID 40886425›Full record

ArticleOral oncology2025

Management of HPV+ head and neck squamous cell carcinoma with unknown primary in the era of treatment de-escalation.

Thomas F Barrett, Anthony J Apicelli, Salma Ramadan, Patrik Pipkorn, Paul Zolkind, Jason T Rich, Richard A Harbison, Wade Thorstad, Hiram Gay, Nikhil Rammohan and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Oral oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors.

Thomas F BarrettDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Anthony J ApicelliRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Salma RamadanDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Patrik PipkornDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Paul ZolkindDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Jason T RichDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Richard A HarbisonDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
Wade ThorstadRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Hiram GayRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Nikhil RammohanRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Michael J MoravanRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Jennifer De Los SantosRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Peter OppeltRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Douglas AdkinsRobert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA.
Ryan S JacksonDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: jackson.ryan@wustl.edu.
Sidharth V PuramDepartment of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA; Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at the Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: sidpuram@wustl.edu.

Funding

Deciphering epigenetically-regulated pathways to improve targeted therapy for invasion and metastasis in head and neck cancerR01DE032865 · NIDCR · WASHINGTON UNIVERSITY · PI Robi D Mitra, Sidharth Venkata Puram · 2023 to 2026
$2.4M
Dissecting hybrid epithelial-mesenchymal states in head and neck cancerR01DE032371 · NIDCR · WASHINGTON UNIVERSITY · PI Sidharth Venkata Puram · 2023 to 2026
$1.6M
Understanding programs of invasion and metastasis in head and neck cancerK08CA237732 · NCI · WASHINGTON UNIVERSITY · PI PURAM, SIDHARTH VENKATA · 2019 to 2023
$984k
RNA modification and the regulation of partial EMT in head and neck cancerR21DE031072 · NIDCR · WASHINGTON UNIVERSITY · PI PURAM, SIDHARTH VENKATA · 2021 to 2022
$433k
NCI NIH HHS K08 CA237732NIDCR NIH HHS R01 DE032371NIDCR NIH HHS R01 DE032865NIDCR NIH HHS R21 DE031072
6 · The paper itself

Abstract

backgroundManagement of HPV+ HNSCC with unknown primary (SCCUP) remains controversial. A transoral surgery (TOS) for SCCUP with concurrent neck dissection (ND) has excellent rates of primary lesion detection and removal. This approach allows pathologic staging, directed adjuvant radiation therapy (RT), reduced radiation doses, and decreased rates of chemotherapy. De-escalation trials have largely excluded patients with SCCUP.

methodsSingle-center retrospective cohort analysis of patients with p16+ SCCUP between July 2012 and December 2021. Only patients without evidence of a primary tumor on physical or PET-CT exams were included. Kaplan-Meier estimates were computed for both disease-free survival (DFS) and overall survival (OS) for patients treated with standard of care versus on-trial. Details of demographics, tumor staging, treatment modalities, recurrence, and rates of gastrostomy tube placement were also analyzed.

results66 patients were included, with 13 patients treated on a de-escalation trial. The primary lesion was detected in 57 patients (86.4%). 5-year OS for the on-trial and standard-of-care groups were 100% and 94.7%, respectively, and 5-year DFS estimates were 100% and 92.8%. Patients treated on-trial had lower radiation doses to the ipsilateral pharyngeal constrictor, ipsilateral salivary glands, oral cavity, and mandible.

conclusionPatients with HPV+ SCCUP treated with TOS and risk-directed adjuvant therapy have excellent OS and DFS, including patients enrolled in de-escalation trials. The majority of primary lesions are found intra-operatively with adequate margin clearance, allowing these patients to be treated similar to other early-stage HPV+ SCC patients. Patients on de-escalation trials received less radiation to organs at risk.

Indexed as

Head and Neck NeoplasmsNeoplasms, Unknown PrimaryPapillomavirus InfectionsSquamous Cell Carcinoma of Head and NeckAdultAgedFemaleHumansMaleMiddle AgedNeck DissectionRetrospective StudiesHuman papillomavirusOropharyngeal squamous cell carcinomaTransoral robotic surgeryTransoral surgeryUnknown primary

Identifiers

PMID40886425
PMCPMC13556924

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.