[Lymph node metastases in the neck of unknown primary tumor]

Cervical lymph nodes represent the most frequent manifestation of lymph node metastases of unknown primary. Nearly 3% of all malignant ENT-tumors are cervical lymph nodes metastases of unknown primary. This disease is a challenge for clinical working physician in diagnosis and therapy.

In a retrospective study we investigated 99 patients with the diagnosis cervical lymph node metastases of unknown primary, which were treated and observed in our department between 1975 and 1995. Within this group we observed the course of 83 patients completely.

The tumor-dependent 5 year-survival-rate was 11%. This is very low, but similar to the literature. 40% of patients, that were operated on neck dissection with or without postoperative irradiation survived tumor-dependent 5 years. In 42 cases we could find a primary tumor. 14 of these primaries were located in the upper aero-digestive-tract, 28 in other regions of the body. The identification of the primary did not improve the prognosis of the patients. A good prognosis was associated with further occult primary, location of the lymph nodes in the upper or middle level of the neck or parotid region and a histology of squamous cell or undifferentiated carcinoma. Signs of poor prognosis were metastasis in the supraclavicular region, of adenocarcinoma and inoperability of the lymph node. The combination therapy of neck dissection and irradiation proved to be best. The extended field radiation of the complete upper aero-digestive-tract did not cause a improvement of tumor-dependent 5-year-survival. We discovered a primary in 5 of 27 patients in this group within the irradiated area. In conclusion extended field radiation must be discussed critically for patients with lymph node metastasis of unknown primary.