Cancer of unknown primary (CUP) of the head and neck: retrospective analysis of 81 patients

Abstract

The treatment of patients with cervical lymph node metastases without detectable primary tumor remains an important challenge, until today, no standard therapy is available. The present study investigated the multimodal treatment of patients with head and neck CUP syndrome (HNCUP) and their follow-up retrospectively. 81 patients with cervical lymph node metastases without a primary tumor were treated at the Departments of Otorhinolaryngology as well as Radiotherapy and Radiation Oncology at the University of Saarland in Homburg, Germany in the period between 1991 and 2013. All patients received routine work-up consisting of CUP panendoscopy and imaging. Neck dissection was then performed in 77% of the patients. The most common histology was squamous cell carcinoma (80%). Ten percent of the patients had distant metastases. All patients underwent primary or adjuvant radiation therapy, or simultaneous radiochemotherapy. After a median follow-up of 3.5 years, the 5-year survival rate was 30%. There was a local recurrence that was known in 20/63 patients (31%) and distant metastases were documented in 19/61 M0 patients (31%). Higher grade late toxicity (grade 3-4) was observed in 12% of patients. Neck dissection and radiation therapy remains an integral part of HNCUP therapy, while the use of chemotherapy could be considered in selected cases. Prospective multicenter randomized trials would be necessary to identify the best target volume and to clarify the role of chemotherapy.

Management of unilateral head and neck carcinoma of unknown primary: Retrospective analysis of the impact of postoperative radiotherapy target volumes

“…Overall, the locoregional relapse rate did not statistically differ between unilateral neck irradiation (17%) and comprehensive radiotherapy (28%). These results are comparable to those of recent studies with neck relapse rate ranging from 6% to 22% after unilateral radiotherapy and 0% to 31% after comprehensive radiotherapy …”

Radiotherapeutic management of cervical lymph node metastases from an unknown primary site – experiences from a large cohort treated with modern radiation techniques

“…Nevertheless, the data show that systemic control remains a challenge in these patients as reflected in median DMFS rates of only 27.5 months. With a median age of 62 years, predominantly male patients and SCC as the most common histology, our patient cohort is comparable to previous CCUP studies in terms of demographic parameters [2,[18][19][20][21]. The majority of lymph node metastases were observed in the upper neck with level II as the most frequent localization, suggesting an occult head-and-neck cancer in the majority of patients [5].…”

“…The majority of lymph node metastases were observed in the upper neck with level II as the most frequent localization, suggesting an occult head-and-neck cancer in the majority of patients [5]. Compared to other retrospective analyses, our oncological results in terms of OS and locoregional control are quite favorable [18]. While older series focused on conventional 2or 3-dimensional radiotherapy techniques reported 5-year survival rates between 22 and 53%, our cohort exhibited a 5-year OS of almost 60% [4,[22][23][24][25].…”

“…Diagnostic workup includes careful clinical examination, cervical nodal ultrasound and panendoscopy, combined with diagnostic tonsillectomy. Computed tomography (CT), magnetic resonance imaging (MRI), and 18 F-fluorodeoxyglucose-positron emission tomography-CT (FDG-PET-CT) are also essential to further clarify the extent of the disease and to assess potential primaries. In this context, the advent of FDG-PET-CT has resulted in detection rates of up to 40% of occult primaries not amenable to conventional diagnostic imaging and also helps to further clarify the extent of the disease [10,11].…”

Metastases of squamous cell carcinoma in the lymph nodes of the neck without the revealed primary focus

“…В большинстве изученных случаев метастазов ПКР в лимфатических узлах шеи первичный очаг был выявлен в органах и тканях головы и шеи, за исключением 2 пациентов, у которых диагностирован рак легкого и рак молочной железы. Следовательно, при поиске первичного очага у этого контингента больных в первую очередь нужно обследовать органы головы и шеи, что согласуется с данными литературы [8][9][10].…”