Please use this identifier to cite or link to this item:
Full metadata record
DC FieldValueLanguage
dc.contributor.advisorAromataris, Edoardo-
dc.contributor.advisorBoase, Samuel-
dc.contributor.advisorCarney, Simon-
dc.contributor.authorDharmawardana, Nuwan Shyanaka-
dc.description.abstractUnknown primary head and neck squamous cell carcinoma is a rare condition with poor prognosis compared to tumours with a known primary site. There are no consistent guidelines or strong evidence to guide the management of these tumours. Surgery or radiotherapy are equally common primary treatment modalities for these patients. A systematic review was therefore conducted to assess the effectiveness of primary surgery compared to primary radiotherapy. A pre-defined search strategy was used to search PubMed, Embase and ProQuest databases. Titles and abstracts were screened against inclusion criteria and full texts of potentially relevant studies retrieved to assess final eligibility. These studies underwent critical appraisal by two independent reviewers for assessment of their methodological quality. Five of these studies were included in pooled meta-analysis. Primary outcome measures of interest were overall survival and regional and relapse free survival. Primary emergence, neck recurrence and distant metastasis rates were extracted and analysed to substantiate the primary outcome measures. Following screening of 9376 unique records identified by the search, ten retrospective cohort studies, including a total of 655 participants that analysed data from patient registries, were included in the review. Across the included studies, quality of data synthesis and reporting was poor, especially the stratification of end point survival data, summary statistics, reporting of treatment related toxicities and quality of life measures. Meta-analysis (n=5) revealed no statistically significant difference in overall survival based on the primary treatment modality (HR:0.86, p=0.60) but favoured primary surgery for regional and relapse free survival (HR:0.57, p=0.07). Early stage disease at the time of treatment initiation had improved overall survival, regardless of the treatment modality (HR:0.27, p=0.008). Rate of primary emergence (median = 5%) after five years did not increase when the mucosa was not irradiated in suspected cutaneous cancer patients. However, treatment with neck dissection alone without patient risk stratification increased primary emergence rates as well as neck failure rates. In conclusion, there is no treatment modality dependent difference in overall survival or regional and relapse free survival. Cutaneous origin of unknown primary head and neck cancers need to be considered and treated differently to cancers of occult mucosal origin.en
dc.subjecthead and neck canceren
dc.subjectunknown primaryen
dc.subjectsquamous cell carcinomaen
dc.titleTreatment of unknown primary head and neck squamous cell carcinoma: primary surgery versus primary radiotherapyen
dc.contributor.schoolSchool of Medical Sciencesen
dc.provenanceThis electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
dc.description.dissertationThesis (MClinSc.) -- University of Adelaide, Adelaide Medical School, 2019en
Appears in Collections:Research Theses

Files in This Item:
File Description SizeFormat 
Dharmawardana2019_MClinSc.pdf4.1 MBAdobe PDFView/Open

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.