Introduction: Carcinomas of unknown primary site (CUP) of the head and neck have historically been worked up and managed heterogeneously. Failure to identify a primary site may result in large radiotherapy mucosal volumes. Transoral approaches such as Transoral Robotic Surgery (TORS) may improve the yield of identifying hidden primaries. We aim to assess the oncological and functional outcomes of a combined treatment approach with TORS and tailored radiotherapy.
Methods and analysis: Twenty-five patients with metastatic squamous cell carcinoma to the neck without clinical or radiographic evidence of a primary site will be enrolled in a phase II trial. Patients will undergo a diagnostic or therapeutic approach with TORS based on specific algorithms incorporating tailored radiotherapy according to the location and laterality of the primary tumour. The primary outcome is to evaluate the out-of-field failure rate over a 2-year period. Secondary outcomes include identification rates, survival outcomes, patient reported outcomes and functional swallowing outcomes.
Ethics and dissemination: The University Health Network Research Ethics Board approved this study (ID 15-9767). The results will be published in an open access journal.
Trial registration number: NCT03281499.
Keywords: head and neck cancer; health technology assessment; human papillomavirus; oropharynx; quality of life; radiotherapy; randomized controlled trial; survival; transoral robotic surgery.
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