Neck Lymph Node Metastases from an Unknown Primary Tumor

IntroductionThe purpose of the present retrospective study was to review outcome and patterns of failure of patients who were treated with radiotherapy for cervical lymph node metastases from an unknown primary site (CUP).Patients and MethodsBetween 2000 and 2009, 34 patients diagnosed with squamous cell CUP were admitted to radiotherapy in curative intent. In 26 of 34 patients (76%) neck dissection was performed prior to radiotherapy, extracapsular extension (ECE) was seen in 20 of 34 patients (59%). Target volumes included the bilateral neck and panpharyngeal mucosa. Concomitant chemotherapy was applied in 14 of 34 patients (41%).ResultsAfter a median follow-up of 45 months for the entire group, 2 of 34 patients (6%) presented with an isolated regional recurrence, another 2 of 34 patients (6%) developed both local and distant recurrence, and 6 of 34 patients (18%) had distant failure only. Estimated overall survival after 2- and 5 -years was 78% and 63%. All patients with N1 or N2a disease (n=6) were disease free after 5 years. ECE, concomitant chemotherapy and involvement of neck levels 4 and 5 were associated with worse overall survival on univariate analysis.ConclusionRadiotherapy of the panpharynx and bilateral neck leads to excellent local control while distant metastases are the most frequent site of failure and prognostically limiting. Therefore intensified concomitant or sequential systemic therapies should be evaluated in future trials.

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“…The estimated OS after 5 years was 63%. Both values are at least in line with or even superior to other published data 9–11…”

Section: Discussionsupporting

confidence: 91%

Cervical Squamous Cell Lymph Node Metastases from an Unknown Primary Site: Survival and Patterns of Recurrence after Radiotherapy

Gani

Eckert

Müller

et al. 2013

Clin Med Insights Oncol

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“…The overall 2-, 5-, and 10-year survival rates were similar after these two treatments. Previous studies on the treatment of HNCUP came to different conclusions: some studies found a statistically increased survival rate for treatment including ND [4, 8, 29]. In one study, the indication for ND was questioned since no significant difference in survival was found between the groups [14], and in other studies no statistically significant differences in survival between the treatment groups were reported, and no conclusions about the optimal treatment were drawn [2, 6, 13, 22, 30–32].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection

Axelsson

Nyman

Haugen-Cange

et al. 2017

J of Otolaryngol - Head & Neck Surg

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BackgroundHead and neck cancer of unknown primary (HNCUP) is rare and prospective studies are lacking. The impact of different prognostic factors such as age and N stage is not completely known, the optimal treatment is not yet established, and the reported survival rates vary. In the last decade, human papilloma virus (HPV) has been identified as a common cause of and important prognostic factor in oropharyngeal cancer, and there is now growing interest in the importance of HPV for HNCUP. The aim of the present study on curatively treated HNCUP was to investigate the prognostic importance of different factors, including HPV status, treatment, and overall survival.MethodsA search for HNCUP was performed in the Swedish Cancer Registry, Western health district, between the years 1992–2009. The medical records were reviewed, and only patients with squamous cell carcinoma or undifferentiated carcinoma treated with curative intent were included. The tumor specimens were retrospectively analyzed for HPV with p16 immunostaining.ResultsSixty-eight patients were included. The mean age was 59 years. The majority were males, and had N2 tumors. Sixty-nine percent of the tumors were HPV positive using p16 staining. Patients who were older than 70 years, patients with N3-stage tumors, and patients with tumors that were p16 negative had a significantly worse prognosis. The overall 5-year survival rate for patients with p16-positive tumors was 88% vs 61% for p16-negative tumors. Treatment with neck dissection and postoperative radiation or (chemo) radiation had 81 and 88% 5-year survival rates, respectively. The overall and disease-free 5-year survival rates for all patients in the study were 82 and 74%.ConclusionsCuratively treated HNCUP had good survival. HPV infection was common. Independent prognostic factors for survival were age over 70 years, HPV status and N3 stage. We recommend that HPV analysis should be performed routinely for HNCUP. Treatment with neck dissection and postoperative radiation or (chemo) radiation showed similar survival rates.

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“…For example, Christiansen et al observed significantly higher 5-year survival and neck control rates (55.6% vs. 18.2% and 90.9% vs. 40.9%, respectively) for patients treated with neck dissection and adjuvant RT compared with biopsy plus RT (20) . Wallace et al similarly noted superior neck control and cause-specific survival in HNCUP patients undergoing neck dissection in addition to RT (21) .…”

Section: Discussionmentioning

confidence: 99%

Head and neck squamous cell carcinoma of unknown primary: Neck dissection and radiotherapy or definitive radiotherapy

et al. 2013

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Background Management of head and neck carcinoma from unknown primary (HNCUP) remains controversial, with neck dissection and radiotherapy (ND+RT) or definitive RT both commonly used. We aimed to characterize HNCUP and retrospectively compare outcomes for patients treated with ND+RT versus definitive RT. Methods From 1994-2009, 41 HNCUP patients underwent either ND+RT (n=22) or definitive RT+ concurrent chemotherapy (n=19) at our institution. Treatment outcomes were compared using Kaplan-Meier methods and log-rank test. Results There were no differences between patients treated with ND+RT and definitive RT in overall survival (OS), progression-free survival (PFS), or locoregional-relapse-free survival, freedom-from-locoregional failure, or freedom-from-distant failure. Among 17 ND+RT patients for whom human papillomavirus (HPV) status could be determined, HPV(+) patients trended towards improved OS (p=0.06)and PFS (p=0.15). Conclusions Neck dissection and post-op RT resulted in similar outcome as definitive RT. The prognostic implications of HPV(+) nodes in HNCUP are similar to those in oropharyngeal primary cancers.

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Neck Lymph Node Metastases from an Unknown Primary Tumor

Abstract: With radical surgery followed by radiotherapy good survival rates in patients with neck metastases from a CUP can be obtained. Whether limited radiotherapy might be equal to extended irradiation and can reduce side effects, must be shown in ongoing clinical trials.

Cited by 34 publications

References 39 publications

Cervical Squamous Cell Lymph Node Metastases from an Unknown Primary Site: Survival and Patterns of Recurrence after Radiotherapy

Cervical Squamous Cell Lymph Node Metastases from an Unknown Primary Site: Survival and Patterns of Recurrence after Radiotherapy

Prognostic factors for head and neck cancer of unknown primary including the impact of human papilloma virus infection

Head and neck squamous cell carcinoma of unknown primary: Neck dissection and radiotherapy or definitive radiotherapy

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