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INTEGRATE - National audit of the management of head and neck squamous cell carcinoma of unknown primary

Award: ENT UK Foundation Grant 2021

Title: INTEGRATE - National audit of the management of head and neck squamous cell carcinoma of unknown primary

Project Lead: John Hardman (INTEGRATE Chair), James Constable (HN subcommittee chair), Chris Hogan (Lead Applicant)

Grant Amount: £1,000

Grant award number: ENTUKFRG001

Status: Final Report



Head and neck squamous cell carcinoma of unknown primary (HNSCCUP) is a rare and challenging condition to manage, representing only around 3% of head and neck cancers. Having presented with metastatic cancer in the neck lymph nodes, considerable time and resources are dedicated to trying to identify the original site of cancer in the upper aerodigestive tract. The hope is that identifying the primary site will help focus subsequent treatment and result in improved oncological and functional outcomes. Understanding the current diagnostic pathways and contemporary management of HNSCCUP patients is key to improving their experience and outcomes. As a result, in association with ENT-UK and the British Association of Head and Neck Oncologists, INTEGRATE (The UK ENT Trainee Research Network) conducted a UK-wide audit of the management and outcomes of HNSCCUP patients treated over a five-year period from January 2015. 

Impact of ENT UK Foundation funding

INTEGRATE applied to the ENT UK Foundation Research Grant Programme for support in running a UK-wide audit of consecutive adults who underwent a PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma, over a 5-year period from 1st January 2015. Patients with no primary site on initial examination and no history of previous head and neck cancer were eligible for inclusion.

This multicentre trainee-led initiative collected data from around 1,000 patients from 57 UK centres, providing a unique opportunity to learn about management of this relatively uncommon presentation on a national scale. Preliminary findings were presented at the National Multidisciplinary Consensus Day on HNSCCUP Management, held in Gateshead in November 2021.

The knowledge and insights gained from understanding the real world impacts of current practice have directly contributed to the new UK MDT Guidelines on Management of HNSCCUP, which are due to be published later this year.

Current Status

The project has completed data collection and analysis.

Methodology for Consensus Day has been published in BMC Medical Research Methodology.

Clinical Otolaryngology are publishing a special supplement on HNSCCUP for which two manuscripts have been prepared: one focusing on investigations for suspected HNSCCUP and one focusing on survival outcomes following treatment for HNSCCUP.

The 6th Edition of the UK MDT Guidelines on Management of HNSCCUP are due to be published by the Journal of Laryngology and Otology later this year.

More Information:

Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative






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