Lymph node metastases in the neck from an unknown primary. Report on 113 patients

A series of 113 patients with cervical lymph node metastases from an unknown primary tumour is reported. The 5-year survival was 5 per cent after chemotherapy and 37 per cent after irradiation. The factors relevant to the prognosis after irradiation were the location of the mass and the total dose given. The prognosis was better if the mass was located in the neck than in the supraclavicular fossa. It is recommended that most patients with metastases in the upper or middle part of the neck from an unknown primary be radically irradiated with extended fields including nasopharynx, oropharynx, hypopharynx, and the opposite upper part of the neck in addition to the side with metastases. The tumour dose should preferably be higher than 50 Gy. With this policy it was possible to obtain a 5-year survival in about 50 per cent in a series of Chinese patients, which is quite comparable with the result of surgery. In the series reported, the primary lesions were detected during follow-up in only 6 per cent of the cases.