The occult head and neck primary: To treat or not to treat?

Sinnathamby, K.; Peters, Lester J.; Laidlaw, C.; Hughes, Peter

doi:10.1016/s0936-6555(05)80066-4

Cited by 59 publications

(49 citation statements)

References 29 publications

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“…After a complete initial workup, the primary site remains unidentified in approximately 2% of patients with MCNs [11]. CUP is a rare disease, and predicting the response to treatment and the prognosis of patients can be difficult; therefore, the range and method of treatment in these patients is a subject of controversy [14,15]. …”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Park

Jung²,

Roh³

et al. 2014

Oncology

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Objective: The presence of metastatic cervical lymph nodes (MCNs) is an unfavorable prognostic factor in head and neck cancer. The total volume of MCNs (MNV) and the lymph node ratio (LNR) may be superior to conventional nodal staging in cervical metastasis from an unknown primary tumor (CUP). We evaluated the prognostic value of MNV and LNR in CUP patients. Methods: Thirty-nine patients with CUP who underwent surgery plus postoperative radiotherapy were reviewed. MNV was measured by preoperative computed tomography and LNR was determined using neck dissection samples. The association of clinicopathologic factors, MNV, and LNR with disease-free survival (DFS) and overall survival (OS) was analyzed. Results: Five-year DFS and OS were 68.4 and 70.8%, respectively, for a median follow-up of 49 months. In multivariate analysis, MNV (>30 ml) was an independent prognostic factor for both DFS and OS (p = 0.004 and p < 0.001, respectively). LNR (>0.14) was identified as an independent predictive factor for DFS (p = 0.041). Conclusion: MNV and LNR are independent prognostic factors in patients with CUP and could facilitate the identification of high-risk patients requiring intensive treatment and surveillance.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Park

Jung²,

Roh³

et al. 2014

Oncology

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“…Series with adjuvant bilateral neck irradiation reported emergence of the primary tumor in 7% to 20% of patients. 6,32,38 We have to be very cautious in comparing these series given their retrospective design and possible inherent biases.…”

Section: -21mentioning

confidence: 99%

Benefit of postoperative chemoradiotherapy for patients with unknown primary squamous cell carcinoma of the head and neck

et al. 2006

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“…Cervical lymph node metastases of squamous cell carcinoma from unknown primary (CUP) represent about 5 % of all head and neck cancers [1][2][3]. Because of the lack of evidence from randomized studies and the early closing of the only randomized study proposed by the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group, the standard therapy has not been identified yet.…”

Section: Introductionmentioning

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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The occult head and neck primary: To treat or not to treat?

Cited by 59 publications

References 29 publications

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor

Benefit of postoperative chemoradiotherapy for patients with unknown primary squamous cell carcinoma of the head and neck

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

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