Cervical node metastasis of occult origin

This study reviewed a 12 year experience with 132 patients who were treated for metastatic carcinoma of the cervical lymph nodes with no apparent primary tumor. Using radical neck dissection as the main treatment modality, a 5 year survival of 50 percent was achieved in 79 patients with epidermoid carcinoma. Survival varied significantly depending on the extent of the tumor in the neck. It was 74 percent in those with stage N1 disease compared with 41 percent in patients with N2 or N3 disease. Recurrence in the neck, the major reason for treatment failure, can probably be reduced by more aggressive use of adjunctive radiotherapy. Primary tumors were identified after therapy in only 15 percent of these patients, and this appeared to have relatively little impact on the outcome. Irradiation and chemotherapy were the preferred treatment modalities in 29 patients with metastatic adenocarcinoma of occult origin. All but one patient died within 29 months. A 53 percent 5 year survival was achieved in 13 patients with anaplastic or undifferentiated carcinoma. Radical neck dissection was employed in 11 patients with melanoma. No primary tumor was ever identified in this group and only one patient remained alive and well after 5 years.