{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:52:51Z","timestamp":1774615971595,"version":"3.50.1"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["1KL2TR001444"],"award-info":[{"award-number":["1KL2TR001444"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>We characterize functional outcomes in head and neck cancer of unknown primary (CUP) based on primary site identification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective study, CUP cases were categorized as known primaries (KP) if a tumor was localized after diagnostic workup or persisting unknown primaries (UP). Age, sex, HPV status, diagnostic methods, and treatments regimens were collected. Pretreatment and short\u2010term posttreatment (3\u20136\u2009months after completion of treatment) weights, PHQ\u20109, Eating Assessment Tool (EAT\u201010), and Voice Handicap Index (VHI\u201010) scores were compared between UP and KP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 67 CUP patients, 35 (52.2%) had identified primaries (91.4% oropharyngeal and 8.6% nasopharyngeal). KP patients were younger (58 vs. 64, <jats:italic>p<\/jats:italic>\u2009=\u20090.04) and more likely to be HPV\u2010positive (88.6% vs. 50%, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Overall detection rates were 16.7% for PET\/CT, 34.7% for direct laryngoscopy, and 46.6% for transoral robotic oropharyngectomy. Diagnostic workup was not significantly different between groups. Patients with KP received smaller intermediate radiation dose volumes (436.5 vs. 278.9\u2009cc, <jats:italic>p<\/jats:italic>\u2009=\u20090.03) and lower doses to the cricopharyngeal muscle (41.6 vs. 24.6\u2009Gy, <jats:italic>p<\/jats:italic>\u2009=\u20090.03).Pretreatment weights, PHQ\u20109, EAT\u201010, and VHI\u201010 scores did not differ between groups. However, posttreatment, UP had greater relative weight loss (\u221214.1% vs. \u22127.6%, <jats:italic>p<\/jats:italic>\u2009=\u20090.032), higher EAT\u201010 scores (12.5 vs. 3, <jats:italic>p<\/jats:italic>\u2009=\u20090.004), and higher PHQ\u20109 scores (6 vs. 1.4, <jats:italic>p<\/jats:italic>\u2009=\u20090.017). Specifically, UP reported more stressful swallowing, difficulty swallowing solids and pills, and swallowing affecting public eating.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>KP patients experienced less weight loss, depression, and reduced swallowing dysfunction, highlighting an early functional benefit of primary tumor identification likely driven by reduced radiation treatment volumes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 134:701\u2013707, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30903","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T12:43:04Z","timestamp":1689684184000},"page":"701-707","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Early Improved Functional Outcomes in Head and Neck Cancer Patients with Primary Tumor Detection"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0485-9042","authenticated-orcid":false,"given":"Sandhya","family":"Kalavacherla","sequence":"first","affiliation":[{"name":"School of Medicine University of California San Diego  La Jolla California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery University of California San Diego  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangwoo S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Dornisch","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liza","family":"Blumenfeld","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery University of California San Diego  San Diego California U.S.A."},{"name":"Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Linnemeyer\u2010Risser","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery University of California San Diego  San Diego California U.S.A."},{"name":"Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parag","family":"Sanghvi","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  San Diego California U.S.A."},{"name":"Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1689-3275","authenticated-orcid":false,"given":"Theresa","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery University of California San Diego  San Diego California U.S.A."},{"name":"Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California  San Diego California U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,18]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13459"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soc.2015.03.001"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21753"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.3419"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.14421"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27625"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23465"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.3342\/ceo.2013.6.3.117"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30410-3"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.130.9.1100"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.458"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31109"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489414558107"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.3228"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000375148"},{"issue":"2","key":"e_1_2_6_17_1","first-page":"77","article-title":"New insights into human papillomavirus\u2010associated head and neck squamous cell carcinoma","volume":"33","author":"Boscolo\u2010Rizzo P","year":"2013","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-017-1206-x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.03.079"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2017.07.019"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23385"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canrad.2021.02.001"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28200"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2020.38.15_suppl.6508"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01752"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2021.105620"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.172"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.30903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T06:08:33Z","timestamp":1705903713000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.30903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,18]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1002\/lary.30903"],"URL":"https:\/\/doi.org\/10.1002\/lary.30903","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,18]]},"assertion":[{"value":"2023-01-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}