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Les entités anatomocliniques des CAPI relevant d’une prise en charge spécifique

Carcinoma of unknown primary: favourable subsets

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Oncologie

Abstract

Carcinoma of unknown primary (CUP) origin is a quite heterogeneous entity with a poor prognosis. It accounts for about 5% of all neoplasms. CUP is defined as a histologically confirmed diagnosis of malignancy in patients with unremarkable medical history, normal physical examination and routine blood tests, and normal computed tomography. Among CUPs, several subsets have been identified as likely to be associated with a better life expectancy after specific treatment. About 15% of CUPs correspond to those specific subtypes: metastatic disease of lymph nodes such as nodal midline distribution, isolated metastases to axillary nodes, cervical involvement with squamous histology or inguinal nodal involvement; peritoneal papillary serous carcinomatosis in women; metastatic neuroendocrine carcinoma; osteoblastic bone metastases with elevated PSA in men; a single metastatic site. Thus, ruling out the primary and recognizing one of these subsets appear necessary in the management of patients with CUP tumours.

Résumé

Les carcinomes de primitif inconnu (CAPI) forment un groupe de tumeurs hétérogènes dont le primitif n’est pas identifié après un bilan clinicobiologique et radiologique. Environ 5 % des cancers sont des CAPI. Ce sont des cancers de mauvais pronostic. Parmi ces CAPI, plusieurs entités ont étéindividualisées qui, grâce à une prise en charge spécifique, ont un meilleur pronostic. Environ 15 % des patients atteints d’un CAPI correspondent à un sous-groupe de bon pronostic. On individualise ainsi des tumeurs avec atteinte ganglionnaire isolée comme les adénopathies axillaires de type adénocarcinome chez une femme, les adénopathies cervicales d’un carcinome épidermoïde, les adénopathies inguinales d’un carcinome épidermoïde, les tumeurs de la ligne médiane ou la carcinose péritonéale papillaire séreuse chez la femme, les tumeurs neuroendocrines, les métastases osseuses chez l’homme avec PSA élevéet les CAPI avec site métastatique unique. La prise en charge initiale d’un CAPI doit donc comprendre dans le même temps une recherche du primitif et une mise en évidence éventuelle d’un de ces sous-groupes.

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Références

  1. Abbruzzese JL, Abbruzzese MC, Lenzi R, et al. (1995) Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin. J Clin Oncol 13: 2094–2103

    PubMed  CAS  Google Scholar 

  2. Beldì D, Jereczek-Fossa BA, D’Onofrio A, et al. (2007) Role of radiotherapy in the treatment of cervical lymph node metastases from an unknown primary site: retrospective analysis of 113 patients. Int J Radiat Oncol Biol Phys 69: 1051–1058

    PubMed  Google Scholar 

  3. Boscolo-Rizzo P, Gava A, Da Mosto MC (2007) Carcinoma metastatic to cervical lymph nodes from an occult primary tumor: the outcome after combined-modality therapy. Ann Surg Oncol 14: 1575–1582

    Article  PubMed  Google Scholar 

  4. Bridgewater J, van Laar R, Floore A, et al. (2008) Gene expression profiling may improve diagnosis in patients with carcinoma of unknown primary. Br J Cancer 98: 1425–1430

    Article  PubMed  CAS  Google Scholar 

  5. Bugat R, Bataillard A, Lesimple T, et al. (2003) Summary of the Standards, Options and Recommendations for the management of patients with carcinoma of unknown primary site (2002). Br J Cancer 89(Suppl 1): S59–S66

    Article  PubMed  Google Scholar 

  6. Chen KT, Flam MS (1986) Peritoneal papillary serous carcinoma with long-term survival. Cancer 58: 1371–1373

    Article  PubMed  CAS  Google Scholar 

  7. Culine S, Lortholary A, Voigt JJ, et al. (2003) Cisplatin in combination with either gemcitabine or irinotecan in carcinomas of unknown primary site: results of a randomized phase II study-trial for the French Study Group on Carcinomas of Unknown Primary (GEFCAPI 01) J Clin Oncol 21(18): 3479–3482

    Article  PubMed  CAS  Google Scholar 

  8. Ellerbroek N, Holmes F, Singletary E, et al. (1990) Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin. Cancer 66: 1461–1467

    Article  PubMed  CAS  Google Scholar 

  9. Foroudi F, Tiver KW (2000) Occult breast carcinoma presenting as axillary metastases. Int J Radiat Oncol Biol Phys 47:143–147

    PubMed  CAS  Google Scholar 

  10. Fox RM, Woods RL, Tattersall MH, et al. (1979) Undifferentiated carcinoma in young men: the atypical teratoma syndrome. Lancet 1: 1316–1318

    Article  PubMed  CAS  Google Scholar 

  11. Grau C, Johansen LV, Jakobsen J, et al. (2000) Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 55: 121–129

    Article  PubMed  CAS  Google Scholar 

  12. Greco FA, Rodriguez GI, Shaffer DW, et al. (2004) Carcinoma of unknown primary site: sequential treatment with paclitaxel-carboplatin-etoposide and gemcitabine-irinotecan: a Minnie Pearl Cancer Research Network phase II trial. Oncologist 9: 644–652

    Article  PubMed  CAS  Google Scholar 

  13. Greco FA, Vaughn WK, Hainsworth JD (1986) Advanced poorly differentiated carcinoma of unknown primary site: recognition of a treatable syndrome. Ann Intern Med 104: 547–553

    PubMed  CAS  Google Scholar 

  14. Guarischi A, Keane TJ, Elhakim T (1987) Metastatic inguinal nodes from an unknown primary neoplasm: a review of 56 cases. Cancer 59: 572–577

    Article  PubMed  CAS  Google Scholar 

  15. Hainsworth JD, Spigel DR, Litchy S, et al. (2006) Phase II trial of paclitaxel, carboplatin, and etoposide in advanced poorly differentiated neuroendocrine carcinoma: a Minnie Pearl Cancer Research Network Study. J Clin Oncol 24: 3548–3554

    Article  PubMed  CAS  Google Scholar 

  16. Johansen J, Buus S, Loft A, et al. (2008) Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 30: 471–478

    Article  PubMed  Google Scholar 

  17. Klem ML, Mechalakos JG, Wolden SL, et al. (2008) Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy. Int J Radiat Oncol Biol Phys 70: 1100–1107

    PubMed  Google Scholar 

  18. Levi F, Te VC, Erler G, et al. (2002) Epidemiology of unknown primary tumours. Eur J Cancer 38: 1810–1812

    Article  PubMed  CAS  Google Scholar 

  19. Moertel CG, Kvols LK, O’Connell MJ, et al. (1991) Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin. Evidence of major therapeutic activity in the anaplastic variants of these neoplasms. Cancer 68: 227–232

    Article  PubMed  CAS  Google Scholar 

  20. Nystrom JS, Weiner JM, Heffelfinger-Juttner J, et al. (1977) Metastatic and histologic presentations in unknown primary cancer. Semin Oncol 4: 53–58

    PubMed  CAS  Google Scholar 

  21. Pavlidis N, Briasoulis E, Hainsworth J, et al. (2003) Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 39: 1990–2005

    Article  PubMed  CAS  Google Scholar 

  22. Probert JC (1970) Secondary carcinoma in cervical lymph nodes with an occult primary tumour: a review of 61 patients including their response to radiotherapy. Clin Radiol 21: 211–218

    Article  PubMed  CAS  Google Scholar 

  23. Ransom DT, Patel SR, Keeney GL, et al. (1990) Papillary serous carcinoma of the peritoneum: a review of 33 cases treated with platin-based chemotherapy. Cancer 66: 1091–1094

    Article  PubMed  CAS  Google Scholar 

  24. Sève P, Billotey C, Broussolle C, et al. (2007) The role of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography in disseminated carcinoma of unknown primary site. Cancer 109: 292–299

    Article  PubMed  Google Scholar 

  25. Smith PE, Krementz ET, Chapman W (1967) Metastatic cancer without a detectable primary site. Am J Surg 113:633–637

    Article  PubMed  CAS  Google Scholar 

  26. Stewart JF, Tattersall MH, Woods RL, et al. (1979) Unknown primary adenocarcinoma: incidence of over-investigation and natural history 1(6177): 1530–1533

    CAS  Google Scholar 

  27. Tell DT, Khoury JM, Taylor HG, et al. (1985) Atypical metastasis from prostate cancer. Clinical utility of the immunope-roxidase technique for prostate-specific antigen. Jama 253: 3574–3575

    Article  PubMed  CAS  Google Scholar 

  28. Van der Gaast A, Verweij J, Henzen-Logmans SC, et al (1990) Carcinoma of unknown primary: identification of a treatable subset? Ann Oncol 1: 119–122

    PubMed  Google Scholar 

  29. Varadarajan R, Edge SB, Yu J, et al. (2006) Prognosis of occult breast carcinoma presenting as isolated axillary nodal metastasis. Oncology 71: 456–459

    Article  PubMed  Google Scholar 

  30. Vlastos G, Jean ME, Mirza AN, et al. (2001) Feasibility of breast preservation in the treatment of occult primary carcinoma presenting with axillary metastases. Ann Surg Oncol 8: 425–431

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Groupe hospitalier Diaconesses-Croix-Saint-Simon, 18, rue du Sergent-Bauchat, F-75012, Paris, France

    A. Plantade

  2. Institut de cancérologie de la Loire, 108 bis, avenue Albert-Raimond, F-42270, Saint-Priest-en-Jarez, France

    L. Saban-Roche & Y. Merrouche

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  1. A. Plantade
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  2. L. Saban-Roche
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  3. Y. Merrouche
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Correspondence to A. Plantade.

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Plantade, A., Saban-Roche, L. & Merrouche, Y. Les entités anatomocliniques des CAPI relevant d’une prise en charge spécifique. Oncologie 10, 713–717 (2008). https://doi.org/10.1007/s10269-008-0987-z

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  • DOI: https://doi.org/10.1007/s10269-008-0987-z

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