The Journey of the Unknown Primary in the HPV Era: Evaluation, Treatment, Surveillance and Management of Oligometastatic Disease

Management of unknown primary head and neck squamous cell carcinomas has evolved as the incidence of p16 positive disease among head and neck cancer patients has increased. This activity discusses the diagnostic steps to identify a primary site and treatment of patients where primary is and is not identified. We also discuss post-treatment surveillance of p16 positive patients including the role of TTMV-HPV DNA as a surveillance tool. Finally, we discuss management options for patients with oligometastatic disease.

Topics:

  1. Work-up and Treatment of Unknown Primary p16 Positive Head and Neck Squamous Cell Carcinoma
    Jessica Wen-chia Lee, MD
  2. Surveillance of p16 Positive Head and Neck Squamous Cell Carcinoma: Examination, Imaging and Biomarkers 
    Edina C. Wang, MD
  3. Management of Metastatic HPV+ Head and Neck Cancers
    Musaddiq Javvad Awan, MD
  4. Q and A
    Virginia Diavolitsis, MD - Moderator
    Full Panel

This activity is available from April 7, 2026, through 11:59 p.m. Eastern time on April 6, 2028. 

The content was originally presented and recorded at the 2025 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of radiation oncologists, physicists, radiation therapists, radiation dosimetrists, residents and ear, nose and throat specialists.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Explain the steps in evaluation of a patient with an unknown primary p16 positive head and neck squamous cell carcinoma and management of patients where primary site is not identified. 
  • Discuss the role of TTMV-HPV DNA as a surveillance tool for patients with p16 positive head and neck squamous cell carcinoma. 
  • Describe management options for patients with oligometastatic p16 positive head and neck squamous cell carcinoma. 
Course summary
Available credit: 
  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.
Course opens: 
04/07/2026
Course expires: 
04/06/2028
Cost:
$149.00
Rating: 
0

Moderator:  

  • Virginia Diavolitsis, MD, is employed by The Ohio State University and Riverside Radiation Oncology, Inc. Dr. Diavolitsis has no relevant financial relationship with ineligible companies to disclose. 

Speakers: 

  • Jessica Wen-chia Lee, MD, is employed by the Mid-Atlantic Permanente Medical Group. Dr. Lee has no relevant financial relationship with ineligible companies to disclose.
  • Edina C. Wang, MD, is employed by Duke University Medical Center. Dr. Wang has no relevant financial relationship with ineligible companies to disclose.
  • Musaddiq Javvad Awan, MD, is employed by Medical College of Wisconsin. Dr. Awan receives research support from NIH and Genentech. 

Planners: 

  • Malcolm Mattes, MD is employed at Rutgers Cancer Institute. Dr. Mattes received research/grant funding from Gilead Sciences (relationship ended 8/30/2025). Dr. Mattes has no relevant financial relationship with ineligible companies. 
  • Parul Barry, MD, is employed by the University of Pittsburgh Medical Center. Dr. Barry has no relevant financial relationship with ineligible companies. 
  • Michael Haddock, MD, is employed by Mayo Clinic and has no relevant financial relationship with ineligible companies to disclose.
  • Manisha Palta, MD, is employed by Duke Cancer Center and Duke University Hospital. Dr. Palta receives grant/research funding from Merck and Varian Medical Systems. 
  • Salma Jabbour, MD, is employed by Rutgers Cancer Institute. Dr. Jabbour receives grant/research funding from Merck & Co., Inc. and Beigene. Dr. Jabbour receives compensation/payment as a consultant with Radialogica and IMX Medical. 

   All relevant financial relationships have been mitigated.

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Available Credit

  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.

Price

Cost:
$149.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

  • Nonmember: $149
  • Member: $99
  • Member-in-Training: $49
  • Student/Graduate Student/PGY-1 Member: $49
  • Postdoctoral Fellow Member: $49

If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date. 

Participants using ASTRO Academy activities to satisfy the requirement of a Continuing Certification (MOC) program should verify the credit number and type and availability dates of any activity before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased activities that do not align with their MOC requirement.

The activity and its materials will only be available on the ASTRO website until April 6, 2028, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date. 

Required Hardware/software

One of the two latest versions of Google Chrome, Mozilla Firefox, Internet Explorer or Safari.