{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T12:57:03Z","timestamp":1772715423460,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Treatment of patients with head and neck squamous cell carcinoma of unknown primary (CUP) is challenging. Given the relative rarity of this condition and the recent use of primary transoral robotic surgery (TORS) in modern diagnostic and treatment algorithms, long\u2010term oncologic outcomes are unclear. The objectives were to evaluate oncologic outcomes of patients treated with TORS for management of CUP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case series was conducted at a tertiary care academic medical center from 2010 to 2021. All patients with HPV\u2010mediated CUP who underwent TORS\u2010assisted endoscopy were included. CUP was defined as biopsy\u2010proven squamous cell carcinoma in a cervical lymph node with uncertain primary location following standard\u2010of\u2010care clinical and radiologic assessment. Primary outcomes were recurrence\u2010free survival and overall survival. Secondary outcomes included usage of radiation and chemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 157 patients were included in the study. Median follow\u2010up time was 62\u2009months. Primary tumor was identified in 88% of patients. Surgery alone was performed in 21%, although adjuvant therapy was recommended but declined in 13%. Adjuvant radiation was completed in 46% and adjuvant chemoradiation in 33%. Two\u2010thirds of patients avoided chemoradiation. Overall survival was 94% and recurrence\u2010free survival was 92% at 5\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the largest reported experience to date of TORS\u2010assisted management of CUP, we demonstrate that this approach facilitates a high rate of identification of occult mucosal malignancies and can eliminate the need for chemotherapy and potentially radiation therapy in select patients without compromising excellent oncologic and functional outcomes.<\/jats:p>\n                    <jats:p>Level of Evidence: 4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.32449","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T08:52:11Z","timestamp":1755075131000},"page":"4707-4715","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of\n                    <scp>HPV<\/scp>\n                    + Oropharyngeal Carcinoma of Unknown Primary Following Transoral Robotic Surgery"],"prefix":"10.1002","volume":"135","author":[{"given":"Theodore A.","family":"Gobillot","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5004-6600","authenticated-orcid":false,"given":"Austin","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jake J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6639-8830","authenticated-orcid":false,"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devraj","family":"Basu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Bert W.","family":"O'Malley","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Maryland  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Gregory","family":"Farwell","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Cannady","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Lukens","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Gentile","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason G.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Medical University of South Carolina  Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ara A.","family":"Chalian","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lova","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Hematology\u2010Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Lakshmipathy","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roger B.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of Hematology\u2010Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher H.","family":"Rasskeh","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2148-1643","authenticated-orcid":false,"given":"Karthik","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2010Head &amp; Neck Surgery University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814538605"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-8140(00)00172-9"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-009-0367-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2010.05.004"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21899"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21566"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21635"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2009.145"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20734"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20687"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.3419"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2012.1166"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.11.021"},{"key":"e_1_2_8_15_1","unstructured":"NCCNN \u201cGuidelines: NCCNN Head and Neck Cancer \u201dnccn.org\/professionals\/physician_gls\/pdf\/head\u2010and\u2010neck.pdf."},{"key":"e_1_2_8_16_1","first-page":"870","article-title":"The Development and Validation of a Dysphagia\u2010Specific Quality\u2010Of\u2010Life Questionnaire for Patients With Head and Neck Cancer: The M. D. Anderson Dysphagia Inventory","volume":"127","author":"Chen A. Y.","year":"2001","journal-title":"Archives of Otolaryngology \u2013 Head & Neck Surgery"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22799"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25778"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-020-0359-1"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/91.7.599"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncoscience.159"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature04957"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2006.060053"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12307-012-0099-6"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28200"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21743"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23562"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2017.07.019"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15758-z"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.04.029"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.06.031"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.8841"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0040-1712106"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32164"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130108000817"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816630239"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.32449","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:06:37Z","timestamp":1765875997000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.32449"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":35,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/lary.32449"],"URL":"https:\/\/doi.org\/10.1002\/lary.32449","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]},"assertion":[{"value":"2025-05-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}