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Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site

A retrospective analysis*

Radio(chemo)therapie von Patienten mit zervikalen Lymphknotenmetastasen eines Plattenepithelkarzinoms bei unbekanntem Primärtumor

Eine retrospektive Analyse

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Abstract

Purpose

The goal was to retrospectively review the outcome of patients with cervical lymph node metastases of squamuos cell carcinoma of unknown primary site (CUP) treated with radio(chemo)therapy.

Patients and methods

A total of 65 patients with CUP N1–3, M0, treated between 1988 and 2009 were evaluated: 61 patients underwent surgical resection followed by postoperative radio(chemo)therapy, 4 patients received definitive radiochemotherapy. Radiotherapy of bilateral neck nodes + the parapharyngeal region (COMP-RT) was performed in 48 patients (80%) and a unilateral radiotherapy of lymph nodes (UL-RT) in 17 patients (20%).

Results

After a median follow-up time of 64 months (range 3–219 months), the estimated 2- and 5-year overall survival (OS) rates were 71 ± 6% and 48 ± 7%, respectively. The recurrent free survival (RFS) rate at 2- and 5-years was 58 ± 6% and 48% ± 7%, respectively. Extracapsular spread, resection status (R0 vs. R1/R2), neck lymph node level (I–III vs. IV–V), and Karnofsky index (60–70 vs. 80–100) were significant prognostic factors for OS and RFS in the univariate analysis. Lower nodal stage (N1/N2a vs. N2b/N2c/N3) was significantly associated with a better OS. Resection status and involvement of lymph node level IV significantly affected the OS and RFS in the multivariate analysis. COMP-RT or concurrent chemotherapy was not associated with a better OS or RFS.

Conclusion

An advantage of comprehensive radiotherapy or radiochemotherapy compared with unilateral radiotherapy of lymph nodes was not observed.

Zusammenfassung

Ziel

Retrospektive Analyse der Therapieergebnisse nach Radio(chemo)therapie von Patienten mit zervikalen Lymphknotenmetastasen eines Plattenepithelkarzinoms bei unbekanntem Primärtumor (CUP).

Patienten und Methodik

65 Patienten mit CUP (N1–3, M0) wurden zwischen 1988 und 2009 an der Klinik für Strahlentherapie und Radiologische Onkologie (Technische Universität München) behandelt. 61 Patienten erhielten eine postoperative Strahlentherapie, 4 Patienten eine definitive Strahlenbehandlung. Bei 48 Patienten (80%) wurden die beidseitigen Lymphabflusswege und die parapharyngeale Region, bei 17 Patienten (20%) nur die unilateralen Lymphbahnen bestrahlt.

Ergebnisse

Nach einem medianen Follow-Up von 64 Monaten (3–219 Monate) betrug die 2-Jahres- bzw. 5-Jahres-Überlebensrate 71± 6% bzw. 48± 7%. Die Rezidivfreie Überlebensrate lag nach 2 Jahren bzw. 5 Jahren bei 58 ± 6% und 48 ± 7%. Als signifikante prognostische Faktoren für das Overall-Survival und das rezidivfreie Überleben konnten in der univariaten Analyse die extrakapsuläre Ausbreitung, der Resektionsstatus (R0 vs. R1/R2) die Lokalisation des zervikalen Lymphknotenbefalls (Level I–III vs. IV–V) und der Karnofsky-Index (60–70 vs. 80–100) ermittelt werden. Ein niedriger Nodalstatus (N1/2a vs. N2b/N2c/N3) war mit einem besseren Gesamtüberleben assoziiert. In der multivariaten Analyse war eine R1/R2-Resektion bzw. ein Befall der Level IV–V mit einem kürzeren Gesamt- und rezidivfreien Überleben assoziiert. Weder eine beidseitige Halsbestrahlung noch eine simultane Radiochemotherapie waren mit einem besseren Überleben verknüpft.

Schlussfolgerung

In unserem Kollektiv konnte kein signifikanter Vorteil einer bilateralen Bestrahlung bzw. einer simultanen Chemotherapie nachgewiesen werden.

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Acknowledgements

We thank Dr. Tibor Schuster for supporting us during the statistical analysis and Dr. Waltraud Reuschel for data collection.

Author contributions

Dr. Fakhrian had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany

    K. Fakhrian, R. Thamm, S. Knapp, M. Molls, S. Pigorsch & H. Geinitz

  2. Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    B. Haller

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  1. K. Fakhrian
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  2. R. Thamm
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Correspondence to K. Fakhrian.

Additional information

*Part of these data were presented at DEGRO 2010.

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Fakhrian, K., Thamm, R., Knapp, S. et al. Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site. Strahlenther Onkol 188, 56–61 (2012). https://doi.org/10.1007/s00066-011-0017-8

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  • DOI: https://doi.org/10.1007/s00066-011-0017-8

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