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

Abstract

Purpose: To analyze management and outcomes following (chemo)radiation therapy in patients with cervical lymph node metastases from an unknown primary site (CCUP) in a large single-center cohort.Methods: Between 2008 and 2019, 58 patients with CCUP were treated with (chemo)radiation therapy at the University of Freiburg Medical Center and were included in this analysis. Overall survival (OS), locoregional progression-free survival (PFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The use of diagnostic procedures and their impact on oncological outcomes was analyzed by Cox regression, and treatment-related toxicities were quantified.Results: Median follow-up was 29.9 months (range 4.6-121.9). Twenty-one patients (36.2%) received definitive RT, 35 (60.3%) underwent adjuvant RT, and 2 (3.4%) were treated for oligometastatic disease. Concurrent chemotherapy was prescribed in 40 patients (69.0%). 89.6% of patients completed the prescribed RT, and 65.0% completed the prescribed simultaneous chemotherapy. Locoregional recurrence was observed in 7 patients (12.1%) and distant metastases in 13 cases (22.4%). OS was 81,1, 64.9% and 56,6% after 1, 3 and 5 years, respectively. Univariate analysis of age, gender, extracapsular spread, tumor grading, neck dissection, diagnostic utilization of 18 Ffluorodeoxyglucose positron-emission tomography and concomitant chemotherapy showed no effect on OS (p > 0.05 for all), while smoking was significantly associated with decreased survival (p < 0.05). There was a trend towards impaired OS for patients with advanced nodal status (pN3) (p = 0.07). Three patients (5.2%) experienced grade 3 radiation dermatitis, and 12 (22.4%) developed grade 3 and 1 (1.7%) grade 4 mucositis.(Continued on next page)

Real-Life Performance of F-18-FDG PET/CT in Patients with Cervical Lymph Node Metastasis of Unknown Primary Tumor

“…Furthermore, the examined collective of patients is similar to the groups of patients examined in the literature, as 84% of the presented patient population were male, 87% between 50 and 80 years of age, and also squamous cell carcinoma was the most common diagnosis (70%) after histopathological lymph node examination. Similarly, cervical lymph node level II was the most commonly reported affected cervical lymph level both in this study and in the literature [ 10 ].…”

Standardized Diagnostics Including PET-CT Imaging, Bilateral Tonsillectomy and Neck Dissection Followed by Risk-Adapted Post-Operative Treatment Favoring Radio-Chemotherapy Improve Survival of Neck Squamous Cell Carcinoma of Unknown Primary Patients

“…cisplatin-based PORCT already introduced in 2004. However, the treatment in cohort 2 is in line with recommendations according to guidelines and clinical evidence (7,8,(25)(26)(27)(28)(30)(31)(32)(33). Some analyses suffer from impossibility to obtain pathologic data not included in the available reports, and molecular data including p16 status is missing especially in cohort 1.…”

Head and Neck Cancer of Unknown Primary: A Multicenter Retrospective Cohort study in Northern Thailand, an Endemic Nasopharyngeal Cancer Area

“…However, the discordant results may be because some studies included other histopathological diagnoses such as adenocarcinoma, malignant melanoma, mucoepidermoid carcinoma, and neuroendocrine carcinoma [ 10 , 22 , 23 ]. In addition, only 2 studies from non-endemic NPC countries [ 10 , 24 ] and 1 study from endemic NPC countries [ 25 ] included undifferentiated carcinoma in the analysis.…”