Cervical lymph node metastases from occult squamous cell carcinoma

Nieder, Carsten; Ang, Kie-Kian

doi:10.1007/s11864-002-0039-7

Cited by 27 publications

(21 citation statements)

References 31 publications

(32 reference statements)

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“…Recent reviews have come to the conclusion that neck dissection and radiotherapy seem to have similar efficacy in early stages (N1), whereas more advanced cases (N2, N3) should be treated by combined approaches [1,5,6]. In our series of 46 patients with unknown primary, the mean survival time was 89 months.…”

Section: Discussionmentioning

confidence: 71%

“…The choice and the extent of diagnostic procedures are still under discussion [3,4]. There is no general consensus but routine diagnostic work-up typically includes physical examination, computed tomography (CT) or magnetic resonance imaging (MRI) of the neck, needle biopsy or excision of suspicious lymph nodes on the affected neck side, and directed biopsies of the upper aerodigestive tract during panendoscopy under anaesthesia [5,6]. Most would advocate at least ipsilateral tonsillectomy, as small tumours can be missed by a biopsy [1].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic work-up and outcome of cervical metastases from an unknown primary

Guntinas‐Lichius

Klußmann

Dinh

et al. 2006

Acta Oto-Laryngologica

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At the primary site FDG-PET showed the best sensitivity with 69% and the highest negative predictive value with 87%. Computed tomography and magnetic resonance imaging had a better specificity with 87% and 95%, respectively. The primary tumour was detected in 23 cases (33%). Frequent primary tumour origin was the palatine tonsil (n=8, 35%), base of the tongue (n=6, 26%) and lung (n=4, 17%). All patients with unknown primary were treated by neck dissection. Adjuvant radiotherapy was performed in 26 patients (57%), concurrent radiochemotherapy was performed in 12 patients (26%). The primary emergence rate was 7%. The 5-year overall survival rate was inferior in patients with detected primary in comparison with patients with unknown primary (22% versus 52%). Significant prognostic factors in case of unknown primary were M stage, smoking, alcohol consumption and tonsillectomy. Radiotherapy but not chemotherapy with carboplatin influenced the overall survival.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Diagnostic work-up and outcome of cervical metastases from an unknown primary

Guntinas‐Lichius

Klußmann

Dinh

et al. 2006

Acta Oto-Laryngologica

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“…Erkal et al reported that 12 of 126 patients (10%) developed squamous cell carcinoma in the head and neck mucosa after initial treatment (9). In the review of Nieder et al, the median rate of emergence of the primary site after extensive radiotherapy was 9.5% (range 2-13%), whereas it was 8.0% (range 5-44%) after ipsilateral radiotherapy (8). As will be discussed later, IMRT with appropriate mucosal irradiation field settings is considered to lead to better treatment outcome by controlling the occult mucosal lesions.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

Yamazaki

Kodaira

Ota

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: To investigate the optimal treatment method and risk factor of neck node metastasis from unknown primary tumors (NUP) treated by radiotherapy. Methods: Retrospective case study based on a multi-institutional survey was conducted by the Japanese Radiation Oncology Study Group. Patients pathologically diagnosed as having NUP from 1998 to 2007 were identified. Univariate and multivariate analyses of overall survival (OS), progression free survival (PFS), neck progression free survival (NPFS) and mucosal progression free survival (MPFS) were evaluated. Results: In total, 130 patients with median age of 65 years were included. Nodal stages N1, N2a, N2b and N2c were observed for 10, 26, 43, 12 and 39 patients, respectively. All the patients received radiotherapy (RT) with neck dissection in 60 and with chemotherapy in 67 cases. The median doses to the metastatic nodes, prophylactic neck and prophylactic mucosal sites were 60.0, 50.4 and 50.4 Gy, respectively. The median follow-up period for surviving patients was 42 months. Among 12 patients, occult primary tumors in the neck region developed after radiotherapy. The 5-year OS, PFS, NPFS and MPFS were 58.1%, 42.4%, 47.3% and 54.9%, respectively. Univariate analysis showed that lower N stage (N1-2b), non-bulky node (<6 cm) and negative extracapsular extension (ECE) status were the factors associated with favorable OS, PFS, NPFS and MPFS. Radical surgery proved to be a favorable factor of OS, NPFS and MPFS. On multivariate analysis, lower N stage and negative ECE status were correlated with improved survival.

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“…However, little impact of CCRT on distant metastases has been observed [14]. ICT can reduce metastases incidence [15], and cisplatin-based ICT decreases the incidence of occult primary disease compared with RT [16,17]. There are other advantages of induction chemotherapy, particularly valued in the setting of unresectable disease.…”

Section: Discussionmentioning

confidence: 99%

Induction Chemotherapy Followed by Radiotherapy in Patients with Cervical Lymph Node Metastases from Unknown Primary Carcinoma

Seol

Choi

Lee

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Cervical metastases from unknown primary tumors are rare and no clear therapeutic options are available. This study was performed to assess the efficacy and safety profiles of induction chemotherapy followed radiotherapy in patients with cervical lymph node metastases from unknown primary cancer. Patients with histological diagnosis of cervical lymph-node metastasis from carcinoma with an unknown primary cancer underwent induction chemotherapy followed by radiotherapy. All patients had squamous cell carcinoma. Induction chemotherapy consisted of 3-4 cycles every 3 weeks of docetaxel (day 1.70 mg/m 2 ) and cisplatin (day 1.75 mg/m 2 ). Radiation therapy (RT) was started with in 10 weeks of the last cycle of chemotherapy, and it was administered 5 days per week. It was given in daily fractions of (1.8) Grays (Gy) of 2 Gy and the total dose to the primary tumor was 70-74 Gy. Neck dissection was reserved for residual disease after definitive radiotherapy. Overall survival, recurrent free survival, and locoregional control were calculated using the Kaplan-Meier method. Twenty one patients with an unknown primary cancer underwent induction chemotherapy and radiotherapy. After induction chemotherapy, 6 patients achieved CR and 8 patients achieved PR. The overall response rate after radiation, was 90.4 % (19 of 21 patients). Neutropenia and infection were the most common grade 3-4 adverse event during induction chemotherapy. Mucositis and dermatitis were the most common grade 3-4 toxicities during radiotherapy. With a median follow-up of 50.6 months, the estimated 2 years OS rates were 71 ± 6 %, respectively. The median OS was 42 months (95 % confidence interval CI 8-65 months). The recurrent-free survival rate at 2 years was 57 %, respectively. In the patients with responder to induction chemotherapy, superior relapse free survival and overall survival rate observed. No occurrence of primary cancer was observed during the follow-up period. Induction chemotherapy followed RT for unknown primarycancer has provided good overall and disease-free survival in all the patients with anacceptable rate of complications. The use of induction chemotherapy and radiationtherapy for more advanced disease led to good clinical results with reasonable toxicities.

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Cervical lymph node metastases from occult squamous cell carcinoma

Cited by 27 publications

References 31 publications

Diagnostic work-up and outcome of cervical metastases from an unknown primary

Diagnostic work-up and outcome of cervical metastases from an unknown primary

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

Induction Chemotherapy Followed by Radiotherapy in Patients with Cervical Lymph Node Metastases from Unknown Primary Carcinoma

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