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Carcinoma Metastatic to Cervical Lymph Nodes From an Occult Primary Tumor: The Outcome After Combined-Modality Therapy

  • Head and Neck
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Abstract

Background

The aim of this retrospective analysis was to analyze the results of treatment of patients with cervical node metastases from carcinoma of occult primary with a policy including neck dissection and postoperative comprehensive radiotherapy.

Methods

Ninety patients were treated with curative intent from 1990 to 2002.

Results

The actuarial rate of neck disease control was 68.8% at 5 years (95% confidence interval [CI], 58.9%–78.7%). On multivariate analysis, the rate of neck disease control was significantly related to lymph nodal metastatic level (P = .006). The actuarial rate of developing head and neck primary tumors at 5 years was 8.9% (95% CI, 2.6%–15.2%). The 5-year actuarial rate of distant metastases was 19.1% (95% CI, 9.4%–28.9%). In multivariate analysis, a statistically significant difference in the rate of distant metastasis was obtained when patients were stratified according to the level of nodal involvement (P = .01) and the presence of extracapsular extension (P = .013). At the time of analysis, 50 of the 90 patients were alive. A total of 32 (35.6%) had died from causes related to their primary disease. Actuarial disease-specific survival at 2 and 5 years was 73.6% (95% CI, 64.3%–82.9%) and 62.8% (95% CI, 51.9%–73.7%), respectively. In multivariate analysis, a statistically significant difference in disease-specific survival was obtained when patients were stratified according to the level of nodal involvement and the presence of extracapsular extension.

Conclusions

Our study seems to support the use of combined-modality therapy in patients with neck metastases from carcinoma of occult primary. However, in the absence of randomized trials, comprehensive irradiation cannot be routinely advised.

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References

  1. Mintzer DM, Warhol M, Martin AM, Greene G. Cancer of unknown primary: changing approaches. A multidisciplinary case presentation from the Joan Karnell Cancer Center of Pennsylvania hospital. Oncologist 2004;9:330–8

    Article  PubMed  Google Scholar 

  2. Briasoulis E, Pavlidis N. Cancer of unknown primary origin. Oncologist 1997;2:142–52

    PubMed  Google Scholar 

  3. De Braud F, Al Sarraf M. Diagnosis and management of squamous cell carcinoma of unknown primary tumor site of the neck. Semin Oncol 1993;20:273–8

    PubMed  Google Scholar 

  4. Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev 2004;30:153–64

    Article  PubMed  Google Scholar 

  5. Haas I, Hoffmann KT, Enger R, Ganzer U. Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol 2002;259:325–33

    Article  PubMed  Google Scholar 

  6. Nieder C, Gregoire V, Ang KK. Cervical lymph node metastases from occult squamous cell carcinoma: cut down a tree to get an apple? Int J Radiat Oncol Biol Phys 2001;50:727–33

    Article  PubMed  CAS  Google Scholar 

  7. Sobin LH, Wittenkind CH (eds). International union against cancer. TNM classification of malignant tumors, 6th edn. New York: Wiley (2002)

  8. Strojan P, Anicin A. Combined surgery and postoperative radiotherapy for cervical lymph node metastases from an unknown primary tumour. Radiother Oncol 1998;49:33–40

    Article  PubMed  CAS  Google Scholar 

  9. Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection. Int J Radiat Oncol Biol Phys 2001;50:55–63

    Article  PubMed  CAS  Google Scholar 

  10. Iganej S, Kagan R, Anderson P, et al. Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of failure. Head Neck 2002;24:236–46

    Article  PubMed  Google Scholar 

  11. Berker JL, Zhen WK, Hoffman HT, McCuloch TM, Buatti JM. Squamous cell carcinoma metastatic to cervical lymph nodes from unknown primary: a changing disease. Int J Radiat Oncol Biol Phys 2000;48:320

    Article  Google Scholar 

  12. Coster JR, Foote RL, Olsen KD, et al. Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy. Int J Radiat Oncol Biol Phys 1992;23:743–9

    PubMed  CAS  Google Scholar 

  13. Nordstrom DG, Hamed HT, Latourette HB. Cervical lymph node metastases from unknown primary. Int J Radiat Oncol Biol Phys 1979;5:73–6

    PubMed  CAS  Google Scholar 

  14. Glynne-Jones RG, Anand AK, Young TE, Berry RJ. Metastatic carcinoma in the cervical lymph nodes from an occult primary: a conservative approach to the role of radiotherapy. Int J Radiat Oncol Biol Phys 1990;18:289–94

    PubMed  CAS  Google Scholar 

  15. Harper CS, Mendenhall WM, Parson JT, Stringer SP, Cassisi NJ, Million RR. Cancer in the neck nodes with unknown primary site: role of mucosa radiotherapy. Head Neck 1990;12:463–9

    Article  PubMed  CAS  Google Scholar 

  16. Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000;55:121–9

    Article  PubMed  CAS  Google Scholar 

  17. McMahon J, Hruby G, O’Brien CJ, et al. Neck dissection and ipsilateral radiotherapy in the management of cervical metastatic carcinoma from an unknown primary. Aust N Z J Surg 2000;70:263–8

    Article  PubMed  CAS  Google Scholar 

  18. Friesland S, Lind MG, Lundgren J, Munck-Wikland E, Fernberg J-O. Outcome of ipsilateral treatment for patients with metastases to neck nodes of unknown origin. Acta Oncol 2001;40:24–8

    Article  PubMed  CAS  Google Scholar 

  19. Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998;20:739–44

    Article  PubMed  CAS  Google Scholar 

  20. Mendenhall WM, Million RR, Cassisi NJ. Squamous cell carcinoma of the head and neck treated with radiation therapy: the role of neck dissection for clinically positive neck nodes. Int J Radiat Oncol Biol Phys 1986;12:733–40

    PubMed  CAS  Google Scholar 

  21. Davidson JD, Harter W, O’Malley BB. Cervical lymph node metastasis from squamous cell carcinoma with unknown primary site. In: Harrison LB, Sessions RB, Hong WK, eds. Head and Neck Cancer. A Multidisciplinary Approach. Philadelphia: Lippincott-Raven, 1999:391–410

    Google Scholar 

  22. Davidson BJ, Ronald Spiro H, Patel S, Patel K, Shah JP. Cervical metastases of occult origin: the impact of combined modality therapy. Am J Surg 1994;168:395–9

    Article  PubMed  CAS  Google Scholar 

  23. Bataini JP, Rodriguez J, Jaulerry C, Brugere J, Ghossein NA. Treatment of metastatic neck nodes secondary to an occult epidermoid carcinoma of the head and neck. Laryngoscope 1987;97:1080–4

    Article  PubMed  CAS  Google Scholar 

  24. Maulard C, Housset M, Brunel P, et al. Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma. Laryngoscope 1992;102:884–90

    Article  PubMed  CAS  Google Scholar 

  25. Ferlito A, Rinaldo A, Devaney KO, et al. Prognostic significance of microscopic and macroscopic extracapsular spread from metastatic tumor in the cervical lymph nodes. Oral Oncol 2002;38:747–51.

    Article  PubMed  Google Scholar 

  26. Koivunen P, Laranne J, Virtaniemi J, et al. Cervical metastasis of unknown origin: a series of 72 patients. Acta Otolaryngol 2002;122:569–74

    Article  PubMed  Google Scholar 

  27. Issing WJ, Taleban B, Tauber S. Diagnosis and management of carcinoma of unknown primary in the head and neck. Eur Arch Otorhinolaryngol 2003;260:436–43

    Article  PubMed  Google Scholar 

  28. Subramain R, Chilla R. Halslymphknotenmetastasen bei unbekanntem Primärtumor. HNO 1995;43:299–303.

    Google Scholar 

  29. Fernandez JA, Suarez C, Martinez JA, Llorente JL, Rodrigo JP, Alvarez JC. Metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary tumour: prognostic factors. Clin Otolaryngol Allied Sci 1998;23:158–63.

    Article  PubMed  CAS  Google Scholar 

  30. Coker DD, Casterline PF, Chambers RG, Jaques DA. Metastases to lymph nodes of the head and neck from an unknown primary site. Am J Surg 1977;134:517–22

    Article  PubMed  CAS  Google Scholar 

  31. Marcial-Vega VA, Cardenes H, Perez CA, et al. Cervical metastases from unknown primaries: radiotherapeutic management and appearance of subsequent primaries. Int J Radiat Oncol Biol Phys 1990;19:919–28

    PubMed  CAS  Google Scholar 

  32. Ries LAG, Harkins D, Krapcho M, et al., eds. SEER Cancer Statistics Review, 1975–2003. Bethesda, MD: National Cancer Institute, 2006. Available at: http://www.seer.cancer.gov/csr/1975_2003/.

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Authors and Affiliations

  1. ENT Department and Regional Center for Head and Neck Cancer, University of Padua, School of Medicine, Treviso Regional Hospital, Treviso, Italy

    Paolo Boscolo-Rizzo MD & Maria Cristina Da Mosto MD

  2. Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy

    Alessandro Gava MD

  3. Viale Umbria 6, IT-30019, Chioggia, Venezia, Italy

    Paolo Boscolo-Rizzo MD

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  1. Paolo Boscolo-Rizzo MD
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  2. Alessandro Gava MD
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  3. Maria Cristina Da Mosto MD
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Correspondence to Paolo Boscolo-Rizzo MD.

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Boscolo-Rizzo, P., Gava, A. & Mosto, M.C.D. Carcinoma Metastatic to Cervical Lymph Nodes From an Occult Primary Tumor: The Outcome After Combined-Modality Therapy . Ann Surg Oncol 14, 1575–1582 (2007). https://doi.org/10.1245/s10434-006-9329-9

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  • DOI: https://doi.org/10.1245/s10434-006-9329-9

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