Browse > Article

Radiotherapy of Neck Node Metastases from an Unknown Primary Cancer  

Lee, Jeong-Eun (Department of Radiation Oncology, Kyungpook National University School of Medicine)
Publication Information
Radiation Oncology Journal / v.25, no.4, 2007 , pp. 219-226 More about this Journal
Abstract
Purpose: The aim of this retrospective analysis was to analyze the results of radiotherapy administered to patients with neck node metastases from an unknown primary cancer, with or without neck dissection. Materials and Methods: From January 1986 to December 2005, 88 patients with neck node metastases from an unknown primary cancer were treated with curative intent. The age of the patients ranged from 35 to 74 years (median age, 59 years). There were 74 male and 14 female patients. Distribution of patients by N status was as follows: N1, 4 patients; N2a, 10 patients; N2b, 48 patients; N2c, 8 patients; N3, 18 patients. Fifty-one patients underwent neck dissection and 37 patients had only a biopsy (31 patients had fine-needle aspiration and 6 patients had an excisional biopsy). All patients received radiotherapy. The follow-up time ranged from 1 to 154 months, with a median time of 32 months. Results: The overall survival (OS) and disease-free survival (DFS) rate at 5 years were 43.9% and 41.7%, respectively. The factors associated with the OS rate were neck dissection, and a subsequent primary tumor. Factors associated with the DFS rate were N stage, neck dissection, and a subsequent primary tumor. Neck failure was noted in 15 patients, distant metastases in 18 patients, and a subsequent primary tumor in 8 patients. Conclusion: With comprehensive radiotherapy given to the bilateral neck and the potential mucosal sites, good survival rates can be obtained in patients with neck node metastases from an unknown primary cancer. However, considering the side effects, a randomized trial is required to determine the optimal radiotherapy volume.
Keywords
Neck node metastasis; Unknown primary; Radiotherapy; Survival;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Million RR, Nicholas JC, Mancuso AA. The unknown primary. In: Million RR, Cassisi NT, eds. Management of Head and Neck Cancer: a Multidisciplinary Approach, 2nd ed. Philadelphia, PA: Lippincott Co. 1994:311-320
2 Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. 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   DOI   ScienceOn
3 Iganej S, Kagan R, Anderson P, et al. Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse. Head Neck 2002;24:236-246   DOI   ScienceOn
4 Glynne-Jones RG, Anand AK, Young TE, Berry RJ. Metastatic carcinoma in the cervical lymph nodes from an occult primary: a conservative approach to the role of radiotherapy. Int J Radiat Oncol Biol Phys 1990;18:289-294   DOI   ScienceOn
5 Abbruzzese JL, Abbruzzese MC, Hess KR, Raber MN, Lenzi R, Frost P. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol 1994;12:1272-1280   DOI
6 Mendenhall WM, Million RR, Cassisi NJ. Squamous cell carcinoma of the head and neck treated with radiation therapy: the role of neck dissection for clinically positive neck nodes. Int J Radiat Oncol Biol Phys 1986;12:733-740   DOI   ScienceOn
7 Christiansen H, Hermann RM, Martin A, Nitsche M, Schmidberger H, Pradier O. Neck lymph node metastases from an unknown primary tumor retrospective study and review of literature. Strahlenther Onkol 2005;181:355-362   DOI
8 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   DOI   ScienceOn
9 Nguyen C, Shenouda G, Black MJ, Vuong T, Donath D, Yassa M. Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal sites. Head Neck 1994;16:58-63   DOI   ScienceOn
10 Harper CS, Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Million RR. Cancer in neck nodes with unknown primary site: role of mucosal radiotherapy. Head Neck 1990;12:463-469   DOI   ScienceOn
11 Pignon JP, Bourhis J, Domenge C, Designé L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000; 355:949-955   DOI
12 De Braud F, al-Sarraf M. Diagnosis and management of squamous cell carcinoma of unknown primary tumor site of the neck. Semin Oncol 1993;20:273–278
13 Wang RC, Goepfert H, Barber AE, Wolf P. Unknown primary squamous cell carcinoma metastatic to the neck. Arch Otolaryngol Head Neck Surg 1990;116:1388-1393   DOI   PUBMED   ScienceOn
14 Nordstrom DG, Tewfik HH, Latourette HB. Cervical lymph node metastases from an unknown primary. Int J Radiat Oncol Biol Phys 1979;5:73-76   PUBMED
15 Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998;20: 739-744   DOI   ScienceOn
16 Friesland S, Lind MG, Lundgren J, Munck-Wikland E, Fernberg JO. Outcome of ipsilateral treatment for patients with metastases to neck nodes of unknown origin. Acta Oncol 2001;40:24-28   DOI
17 Hathaway B, Johnson JT, Piccirillo JF, et al. Chemoradiation for metastatic SCCA: role of comorbidity. Laryngoscope 2001;111:1893-1895   DOI   ScienceOn
18 Park IK, Yun SM, Kim JC. Radiotherapy of metastatic neck nodes from an unknown primary site. The J Kor Soc Thera Raiol Oncol 1997;15:105-111
19 Marcial-Vega VA, Cardenes H, Perez CA, et al. Cervical metastases from unknown primaries: radiotherapeutic management and appearance of subsequent primaries. Int J Radiat Oncol Biol Phys 1990;19:919-928   DOI   ScienceOn
20 Mintzer DM, Warhol M, Martin AM, Greene G. Cancer of unknown primary: changing approaches. A multidisciplinary case presentation from the Joan Karnell Cancer Center of Pennsylvania hospital. Oncologist 2004;9:330-338   DOI
21 Kim K, Chie EK, Wu HG, et al. Treatment outcome of metastatic carcinoma of cervical lymph node from an unknown primary. J Korean Soc Ther Oncol 2005;23:137-142
22 Nieder C, Gregoire V, Ang KK. Cervical lymph node metastases from occult squamous cell carcinoma: cut down a tree to get an apple? Int J Radiat Oncol Biol Phys 2001;50:727-733   DOI   ScienceOn
23 Kaplan EL, Meier P. Non-parametric estimations from incomplete observations. J Am Stat Assoc 1958;53:457-481   DOI
24 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   DOI   ScienceOn
25 Lapeyre M, Malissard L, Peiffert D, et al. Cervical lymph node metastasis from an unknown primary: is a tonsillectomy necessary? Int J Radiat Oncol Biol Phys 1997;39:291-296
26 Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection. Int J Radiat Oncol Biol Phys 2001;50:55-63   DOI   ScienceOn
27 Weir L, Keane T, Cummings B, et al. Radiation treatment of cervical lymph node metastases from an unknown primary: an analysis of outcome by treatment volume and other prognostic factors. Radiother Oncol 1995;35:206-211   DOI   ScienceOn
28 Sinnathamby K, Peters LJ, Laidlaw C, Hughes PG. The occult head and neck primary: to treat or not to treat? Clin Oncol (R Coll Radiol) 1997;9:322-329   DOI   PUBMED   ScienceOn
29 Fogarty GB, Peters LJ, Stewart J, Scott C, Rischin D, Hicks RJ. The usefulness of fluorine 18-labelled deoxyglucose positron emission tomography in the investigation of patients with cervical lymphadenopathy from an unknown primary tumor. Head Neck 2003;25:138-145   DOI   ScienceOn
30 Coster JR, Foote RL, Olsen KD, Jack SM, Schaid DJ, DeSanto LW. Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy. Int J Radiat Oncol Biol Phys 1992;23:743- 749   DOI   PUBMED   ScienceOn
31 Califano J, Leong PL, Koch WM, Eisenberger CF, Sidransky D, Westra WH. Second esophageal tumors in patients with head and neck squamous cell carcinoma: an assessment of clonal relationships. Clin Cancer Res 1999; 5:1862-1867   PUBMED
32 Aslani M, Sultanem K, Voung T, Hier M, Niazi T, Shenouda G. Metastatic carcinoma to the cervical nodes from an unknown head and neck primary site: Is there a need for neck dissection? Head Neck 2007;29:585-590   DOI   ScienceOn
33 Fernandez JA, Suarez C, Martinez JA, Llorente JL, Rodrigo JP, Alvarez JC. Metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary tumour: prognostic factors. Clin Otolaryngol Allied Sci 1998; 23:158-163   DOI   ScienceOn
34 Maulard C, Housset M, Brunel P, et al. Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma. Laryngoscope 1992;102:884- 890   DOI   ScienceOn
35 Greco FA, Hainsworth JD. Cancer of unknown primary site. In: Devia VT Jr, Hellman S, Rosenberg SA, eds. Principles and Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2005:2213-2236
36 Johnson JT, Wagner RL, Myers EN. A long-term assessment of adjuvant chemotherapy on outcome of patients with extracapsular spread of cervical metastases from squamous carcinoma of the head and neck. Cancer 1996;77:181- 185   DOI   ScienceOn
37 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 Biol Phys 1997;37:797-802   DOI   ScienceOn
38 Green FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York, Springer. 2002
39 Browman GP, Hodson DI, Mackenzie RJ, Bestic N, Zuraw L; Cancer Care Ontario Practice Guideline Initiative Head and Neck Cancer Disease Site Group. Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: a systematic review of the published literature with subgroup analysis. Head Neck 2001;23:579-589   DOI   ScienceOn
40 Colletier PJ, Garden AS, Morrison WH, Goepfert H, Geara F, Ang KK. 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   DOI   ScienceOn