Management of neck metastases of unknown primary origin united in two European centers

Unknown primary of the head and neck: A long-term follow-up

“…Recently, Straetmans et al (2015) described satisfactory tumor control in patients (n ¼ 51), although only six patients received radiotherapy of the oropharyngeal mucosa. Only one patient developed a local recurrence 4 years after the primary treatment.…”

“…However, biopsies of the tongue base were taken during the panendoscopy, and prophylactic diagnostic tonsillectomy was performed in every patient to uncover the primary tumor. If regular diagnostic work-up, including panendoscopy, biopsies, and prophylactic tonsillectomy did not reveal the site of the primary tumor, HPV testing is unlikely to contribute to localizing the primary tumor (Straetmans et al, 2015).…”

Accuracy of Diagnostic Methods for Detection of Head and Neck Primary Origin in Metastatic Neck Mass

“…In early-stage neck disease, monomodal therapy is possible, whereas an advanced-stage neck disease usually requires an aggressive multimodal approach, comparable to locally advanced head and neck cancer [83]. Table 2 summarizes larger studies on HNCUP-therapy, including nodal stages of the patients treated, treatment modalities, radiotherapy and surgery specifications and finally control rates and survival data [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…However, when RT was postponed and used for salvage treatment only, ultimate control above the clavicles still reached more than 90% in pN1 situations without ECE [84]. Surgery should also be followed by adjuvant RT in cases of connective tissue invasion (ECE), more than one involved node and a likelihood of residual Abbrevations: UC undifferentiated carcinoma, AC adenocarcinoma, EC epidermoid carcinoma, GCSO glandular carcinoma of salavary origin, IB incision biopsy, CB core biopsy, EB exicision biospy, ND neck dissection, MND modified neck dissection, RND radical neck dissection, pts patients, dRT definitive radiotherapy, pRT postoperative radiotherapy, LRFS locoregional relapse-free survival, NS not specified; *median dose in the 1980s, **median dose in the 1990s; TNM staging referring to UICC/AJCC classification actual when published; Tumor entity SCC if not described otherwise; adapted from references [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] microscopic disease in the neck (R1) [87,88]. In cases without these risk factors postoperative RT could be considered.…”

“…The estimated occurrence of CUP in the head and neck (HNCUP) region varies between 3 and 9%, with histological findings of a squamous cell malignancy in 53-77% of the cases [6][7][8]. The frequency of a subsequent mucosal emergence of the primary site in the head and neck region varies between 4 and 21% percent in the studies reviewed [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The most frequently encountered primary symptom is a cervical mass due to enlarged lymph nodes (94%) [15], mostly located in level 2 (30-50%), followed by level 1 and 3 (10-20%) and 4 and 5 (5-10%) [2,15].…”