Management of Patients with Confirmed Cancer of Unknown Primary: Our Experience


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Loaie El-Helw1,Sarah Kelt2,Caroline Connolly2,Karthik Kalyanasundaram2,Nicola Lane2,Ola Stankiewicz2,Lorraine Duke2,Tracey Harrison2,Victoria Bateman2,Joanne Harrison2
1Royal Stoke Hospital, UK and Mansoura University, Egypt,2UHNM

Abstract

Background

Cancer of unknown primary (CUP) is a heterogeneous group of epithelial tumours that present initially with metastases, and in which a standardised diagnostic work-up cannot identify the original site of malignancy. Unfortunately, the survival of CUP patients remains poor especially in the unfavourable subset. There is a need for new management approaches in these patients.

Method

In this study, we retrospectively reviewed the management of our patients with confirmed CUP. We reviewed their medical notes and electronic records.

Results

Seventeen confirmed CUP patients were actively treated; 9 males (52.9 %) and 8 (47.1%) females. The median age was 69 years. The most common histology was poorly differentiated carcinoma (42.1%). Immunohistochemistry studies were suggestive of the site of cancer primary in 9 patients (52.9%). Eleven patients had PET scan (64.7%).  The sites of tumour origin were suggested in 12 patients (favourable CUP) and were unknown in 5 patients (unfavourable CUP).

Eleven patients (64.7%) were treated with chemotherapy; 5 (29.5%) with local radiotherapy and one (5.9 %) surgical resection. Fifteen patients (88.2%) had only one line of treatment, and 2 patients (11.8 %) had 2 lines.  EOX (epirubicin, oxaliplatin and capecitabine) regimen was most commonly used (4 patients) and paclitaxel and carboplatin (2 patients).  Nine patients (90%) had one regimen and one (10%) had 3 regimens.

The median progression free survival (PFS) was 5 months for patients with unfavourable CUP but was not reached in patients with favourable CUP (p 0.170). The median overall survival were 14 and 7 months for favourable and unfavourable CUP patients respectively (p 0.208).

Conclusion

Cancers of unknown primary differ from other primary tumours in their biological features. Newer diagnostic tools and management approaches are needed especially in patients with unfavourable CUP.