Metastatic squamous cell carcinoma neck with occult primary: A retrospective analysis

Abstract

Introduction:Metastatic carcinoma in the lymph nodes of the neck from an unknown primary is relatively rare, accounting for about 3% of all head and neck cancers. Management of secondary neck of undetermined primary is controversial.Materials and Methods:The case records of all the patients treated in the Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, from Oct 1999 to Sep 2004, were studied and the patients with secondary neck without a known primary tumor were analyzed in detail to elucidate the outcome of various treatment modalities in various stages of the disease. One hundred and forty patients were found to be eligible for this analysis. Initial treatment could be divided into two categories: concurrent chemoradiation (n=76) and radiotherapy alone (n=64).Results:The patients who had received radiotherapy alone (53.1%) had lesser complete response as compared to those who had received chemoradiotherapy (68.4%). The overall survival duration in patients of the radiotherapy treatment group ranged from 5 to 60 months, with an average (±SD) of 31.06 ± 21.01 months, while in the chemoradiotherapy treatment group it ranged from 6 to 60 months, with an average (±SD) of 39.42 ± 21.33 months. Both hematological and nonhematological toxicities, although higher in the chemoradiotherapy group, showed statistically insignificant differences.Conclusion:To the best of our knowledge, this is the only study evaluating the role of concurrent chemoradiation in cases of secondary neck with primary unknown. The improved response rates along with an increased survival (both disease free and overall) show the superiority of chemoradiotherapy in the management of such cases.

Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges

“…When node metastases are found in levels 1-3, the primary site is suspected to be in the head and neck region. Upon affliction of the levels 4–5, the primary tumor most likely is located below the clavicles [ 31 – 33 ]. The time interval between noting the cervical mass and final diagnosis of HNCUP ranges from 2 to 5 months [ 6 , 8 , 34 ].…”

“…The patient usually presents with a painless, unilateral cervical mass. Affliction of the levels 1–3 indicates the primary site to be located in the head and neck region, whereas a mass in levels 4–5 suggests the primary tumor situated at the lower neck (e.g., thyroid gland) or below the clavicles [ 31 – 33 ] (Fig. 1 ).…”

Stratifying risk of malignancy in cystic lateral neck lumps: a multivariant analysis of demographic, radiological and histological investigation factors and the development of a patient-centred risk-predictive tool for malignancy

“…Patients were required to be aged 18 years or older at the time of initial ultrasound scanning, and presenting with an isolated or dominant cystic or necrotic neck mass deep to platysma, in levels Ib, II or III, as these are the most common presenting sites for both branchial cleft cyst and metastatic upper aerodigestive tract SCC. 15,16 If more than one enlarged node was present, there had to be a clearly dominant necrotic or cystic mass, with other nodes at worst only borderline atypical and only mildly enlarged.…”

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

“…The patient usually presents with a painless, unilateral cervical mass. Affliction of the levels 1-3 indicates the primary site to be located in the head and neck region, whereas a mass in levels 4-5 suggests the primary tumor situated at the lower neck (e.g., thyroid gland) or below the clavicles [31][32][33] (Fig. 1).…”

“…When node metastases are found in levels 1-3, the primary site is suspected to be in the head and neck region. Upon affliction of the levels 4-5, the primary tumor most likely is located below the clavicles [31][32][33]. The time interval between noting the cervical mass and final diagnosis of HNCUP ranges from 2 to 5 months [6,8,34].…”