Role of Tonsillectomy in Cervical Squamous Cell Carcinoma With Unknown Primary in Human Papillomavirus–Negative Patients: A Prospective Observational Study

INTRODUCTION: Management of cervical squamous cell carcinoma with unknown primary (SCCUP) continues to evolve with emphasis on tonsillectomy for identification of the primary. While the data from an HPV positive population is compelling, surgical ablation of potential primary sites in the oropharynx with the goal of identifying the primary in HPV negative tumors is debated. METHODS: In this prospective observational study, 21 patients with SCCUP underwent bilateral tonsillectomy in an attempt to identify a possible site of primary. RESULTS: Median age of this cohort was 59 years (39-74 years). Two of twenty patients were p16 positive. Only 1 patient (p16 positive) revealed a primary in the tonsil. Fifteen patients received adjuvant concurrent chemoradiation (CTRT), whereas two patients received adjuvant radiotherapy (RT). Median follow up was 17.6 months (0.26-60 months). The 2-year overall and disease-free survival rates were 81.5% (52.6%-93.7%) and 70.1% (42.1%-86.4%), respectively. No patient evinced mucosal recurrence. CONCLUSIONS: Prevalence of human papilloma virus in patients with SCCUP is very low in India. Role of bilateral tonsillectomy to identify primary lesion in p16 negative patients is questionable.