Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지

Metastatic Carcinoma of an Unknown Primary Site Presented to the Neck

경부 림프절 종대로 발현한 원발 부위 불명의 전이암

  • Kim Tae-Yong (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Joh Yo-Han (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Kim Jin-Su (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Hong Yong-Sang (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Lee Keun-Wook (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Yun Tak (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Song Eun-Ki (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Na Im-Il (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Shin Hyun-Chun (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Kim Dong-Wan (Departments of Internal Medicine, Seoul National University Hospital) ;
  • Rlee Chae-Seo (Departments of Otolaryngology-Head and Neck Surgery, Seoul National University Hospital) ;
  • Sung Myung-Whun (Departments of Otolaryngology-Head and Neck Surgery, Seoul National University Hospital) ;
  • Heo Dae-Seog (Departments of Internal Medicine, Seoul National University Hospital)
  • 김태용 (서울대학교 의과대학 내과학교실) ;
  • 조요한 (서울대학교 의과대학 내과학교실) ;
  • 김진수 (서울대학교 의과대학 내과학교실) ;
  • 홍용상 (서울대학교 의과대학 내과학교실) ;
  • 이근욱 (서울대학교 의과대학 내과학교실) ;
  • 윤탁 (서울대학교 의과대학 내과학교실) ;
  • 송은기 (서울대학교 의과대학 내과학교실) ;
  • 나임일 (서울대학교 의과대학 내과학교실) ;
  • 신현춘 (서울대학교 의과대학 내과학교실) ;
  • 김동완 (서울대학교 의과대학 내과학교실) ;
  • 이재서 (서울대학교 의과대학 이비인후과학교실) ;
  • 성명훈 (서울대학교 의과대학 이비인후과학교실) ;
  • 허대석 (서울대학교 의과대학 내과학교실)
  • Published : 2004.11.01
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Abstract

Background: About 3% of all cancer patients suffer from cancer of unknown primary origin. Generally, carcinoma of unknown primary (CUP) carries a grave prognosis, but primary tumor presented to the neck is exception to this. The aims of study are to determine the role of chemotherapy and to find the prognostic factors in unknown primary tumor presented to the neck. Method and Material: Eighty-four patients were diagnosed with unknown primary tumor presented to the neck between January 1996 and June 2002. Among 84 patients, 43 patients (52%) received chemotherapy, radiation or surgery were performed in 20 patients (23%), 21 patients (25%) had no treatment. Results: The response rates to chemotherapy were 87.5% in CUP only localized to the neck and 44.0% in CUP systemically involved (p=0.012). A median follow-up duration was 6.4 years and overall median survival time was 9 months. The median overall survival time of patients treated with chemotherapy were 17 months and that of patients who received surgery or radiation were 20 months (p=0.3548). The important prognostic factors were performance status and the number of involved organ. Conclusion: The prognosis of patients with CUP presented to the neck is more favorable than that of patients with CUP of other localization. The effectiveness of chemotherapy for CUP only localized to the neck was similar to that of surgery or radiation. The important prognostic factors were performance status and the number of involved organ.

Keywords

References

  1. Le Chevalier T, Cvitkovic E, Caille P, et al: Early metastatic cancer of unknown primary origin at presentation. A clinical study of 302 consecutive autopsied patients. Arch Intern Med. 1988;148:2035-2039 https://doi.org/10.1001/archinte.148.9.2035
  2. Strojan P, Anicin A: Combined surgery and postoperative radiotherapy for cervical lymph node metastases from an unknown primary tumour. Radiother Oncol. 1998;49:33-40 https://doi.org/10.1016/S0167-8140(98)00082-6
  3. Issing WJ, Taleban B, Tauber S: Diagnosis and management of carcinoma of unknown primary in the head and neck. Eur Arch Otorhinolaryngol. 2003;260:436-443 https://doi.org/10.1007/s00405-003-0585-z
  4. Haas I, Hoffmann TK, Engers R, Ganzer U: Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol. 2002;259:325-333
  5. Koivunen P, Laranne J, VIrtaniemi J, et al: Cervical metastasis of unknown origin: a series of 72 patients. Acta Otolaryngol. 2002;122:569-574 https://doi.org/10.1080/00016480260092435
  6. Altman E, Cadman E: An analysis of 1539 patients with cancer of unknown primary site. Cancer. 1986;57:120-124 https://doi.org/10.1002/1097-0142(19860101)57:1<120::AID-CNCR2820570124>3.0.CO;2-M
  7. Colletier PJ, Garden AS, Morrison WH, et al: Postoperative radiation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site: outcomes and patterns of failure. Head Neck. 1998;20:674-681 https://doi.org/10.1002/(SICI)1097-0347(199812)20:8<674::AID-HED3>3.0.CO;2-H
  8. Coster JR, Foote RL, Olsen KD, et al: Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy. Int J Radiat Oncol Bioi Phys. 1992;23:743-749 https://doi.org/10.1016/0360-3016(92)90647-Z
  9. Harper CS, Mendenhall WM, Parsons JT, et al: Cancer in neck nodes with unknown primary site: role.of mucosal radiotherapy. Head Neck. 1990;12:463-469 https://doi.org/10.1002/hed.2880120603
  10. Wang RC, Goepfert H, Barber AE, Wolf P: Unknown primary squamous cell carcinoma metastatic to the neck. Arch OtolaryngoI Head Neck Surg. 1990;116:1388-1393 https://doi.org/10.1001/archotol.1990.01870120034004
  11. de Braud F, Heilbrun LK, Ahmed K, et al: Metastatic squamous cell carcinoma of an unknown primary localized to the neck. Advantages of an aggressive treatment. Cancer. 1989;64:510-515 https://doi.org/10.1002/1097-0142(19890715)64:2<510::AID-CNCR2820640225>3.0.CO;2-2
  12. Jereczek-Fossa BA, Jassem J, Orecchia R: Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev. 2004;30:153-164 https://doi.org/10.1016/j.ctrv.2003.10.001
  13. Medina JE: A rational classification of neck dissection. Otolaryngol Head Neck Surg. 1989;100:169-176 https://doi.org/10.1177/019459988910000301
  14. Green S, Weiss GR: Southwest Oncology Group standard response criteria, endpoint definitions and toxicity criteria. Invest New Drugs. 1992;10:239-253 https://doi.org/10.1007/BF00944177
  15. Lee NK, Byers RM, Abbruzzese JL, Wolf P: Metastatic adenocarcinoma to the neck from an unknown primary source. Am J Surg.1991;162:306-309 https://doi.org/10.1016/0002-9610(91)90137-3
  16. Abbruzzese JL, Abbruzzese MC, Lenzi R. et al: Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin. J Clin Oncol. 1995;13:2094-2103 https://doi.org/10.1200/JCO.1995.13.8.2094
  17. Hillen HF: Unknown primary tumours. Postgrad Med J. 2000;76:690-693 https://doi.org/10.1136/pmj.76.901.690
  18. Varadhachary GR, Abbruzzese JL, Lenzi R: Diagnostic strategies for unknown primary cancer. Cancer. 2004;100:1776-1785 https://doi.org/10.1002/cncr.20202
  19. Talmi YP, Wolf GT, Hazuka M, Krause CJ: Unknown primary of the head and neck. J Laryngol Otol. 1996;110:353-356
  20. Reddy SP, Marks JE: Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation. Int J Radiat Oncol Bioi Phys. 1997;37:797-802
  21. Medini E? Medini AM, Lee CK, et al: The management of metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary. Am J Clin Oncol. 1998;21:121-125 https://doi.org/10.1097/00000421-199804000-00004
  22. Nguyen C, Shenouda G, Black MJ, et al: Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal sites. Head Neck. 1994;16:58-63 https://doi.org/10.1002/hed.2880160112
  23. Jeremic B, Zivic DJ, Matovic M, Marinkovic J: Cisplatin and 5-fluorouracil as induction chemotherapy followed by radiation therapy in metastatic squamous cell carcinoma of an unknown primary tumor localized to the neck. A phase II study. J Chemother. 1993:5:262-265
  24. Jeremic B, Djuric LJ, Jevremovic S, et al: Metastatic squamous cell carcinoma of an unknown primary tumor localized to the neck. J Chemother. 1992;4:41-45 https://doi.org/10.1080/1120009X.1992.11739137
  25. Grau C, Johansen LV, Jakobsen J, et al: Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol. 2000;55:121-129 https://doi.org/10.1016/S0167-8140(00)00172-9
  26. Pasterz R, Savaraj N, Burgess M: Prognostic factors in metastatic carcinoma of unknown primary. J Clin Oncol. 1986;4:1652-1657 https://doi.org/10.1200/JCO.1986.4.11.1652
  27. Briasoulis E, Pavlidis N: Cancer of Unknown Primary Origin. Oncologist. 1997;2:142-152
  28. Hess KR, Abbruzzese MC, Lenzi R, et al: Classification and regression tree analysis of 1000 consecutive patients with unknown primary carcinoma. Clin Cancer Res. 1999;5:3403-3410
  29. Cho EK, Lee KS, Jung CW, et al: Clinical Characteristics and Prognostic Factor of Metastatic Tumor of Unknown primary. J Korean Cancer Assoc. 1999;31 (3):607-616