{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:31:48Z","timestamp":1785799908359,"version":"3.56.0"},"reference-count":25,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,1,16]],"date-time":"2018-01-16T00:00:00Z","timestamp":1516060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R01DE025248\u201001\/R56DE025248\u201001"],"award-info":[{"award-number":["1R01DE025248\u201001\/R56DE025248\u201001"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012287","name":"Andrew Sabin Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012287","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>There are few published studies to guide the treatment of carcinoma metastatic to the neck from an unknown primary (CUP). In this regard, the objective of the current study was to share the authors' current experience treating patients with CUP using intensity\u2010modulated radiation therapy (IMRT), which principally targeted both sides of the neck, the nasopharynx, and the oropharynx.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This was a retrospective study in which an institutional database search was conducted to identify patients with CUP who received IMRT. Data analysis included frequency tabulation, survival analysis, and multivariable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Two\u2010hundred sixty patients met inclusion criteria. The most common lymph node category was N2b (54%). IMRT volumes included the entire pharyngolaryngeal mucosa in 78 patients, the nasopharynx and oropharynx in 167 patients, and treatment limited to the involved neck in 11 patients. Eighty\u2010four patients underwent neck dissections. The 5\u2010year overall survival, regional control, and distant metastases\u2010free survival rates were 84%, 91%, and 94%, respectively. Over 40% of patients had gastrostomy tubes during therapy, and 7% patients were diagnosed with chronic radiation\u2010associated dysphagia. Higher lymph node burden was associated with worse disease\u2010related outcomes, and in subgroup analysis, patients with human papillomavirus\u2010associated disease had better outcomes. No therapeutic modality was statistically associated with either disease\u2010related outcomes or toxicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Comprehensive IMRT with treatment to both sides of the neck and to the oropharyngeal and nasopharyngeal mucosa results in high rates of disease control and survival. The investigators were unable to demonstrate that treatment intensification with chemotherapy or surgery added benefit or excessive toxicity. <jats:bold><jats:italic>Cancer<\/jats:italic> 2018;124:1415\u201027<\/jats:bold>. \u00a9 <jats:italic>2018 American Cancer Society<\/jats:italic>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.31235","type":"journal-article","created":{"date-parts":[[2018,1,16]],"date-time":"2018-01-16T13:55:54Z","timestamp":1516110954000},"page":"1415-1427","source":"Crossref","is-referenced-by-count":25,"title":["Outcomes of patients diagnosed with carcinoma metastatic to the neck from an unknown primary source and treated with intensity\u2010modulated radiation therapy"],"prefix":"10.1002","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1626-2657","authenticated-orcid":false,"given":"Mona","family":"Kamal","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"},{"name":"Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine Ain Shams University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah S. R.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"},{"name":"Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine University of Alexandria Alexandria Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5264-3994","authenticated-orcid":false,"given":"Clifton David","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1069-4822","authenticated-orcid":false,"given":"Erich M.","family":"Sturgis","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faye M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Thoracic\/Head and Neck Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas"},{"name":"The University of Texas Graduate School of Biomedical Sciences Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William H.","family":"Morrison","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Brandon","family":"Gunn","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Volpe","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"},{"name":"University of Milan, Department of Oncology and Hemato\u2010Oncology University of Milan Milano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sweet Ping","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-215X","authenticated-orcid":false,"given":"Renata","family":"Ferrarotto","sequence":"additional","affiliation":[{"name":"Department of Thoracic\/Head and Neck Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Frank","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heath D.","family":"Skinner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David I.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Garden","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,1,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21899"},{"key":"e_1_2_8_3_1","unstructured":"National Comprehensive Cancer Network (NCCN).NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines)\u2010Head and Neck Cancers. 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