Treatment of epidermoid and undifferentiated carcinomas from occult primaries presenting in cervical lymph nodes

We treated 83 patients with epidermoid or undifferentiated carcinoma in cervical neck nodes without an obvious primary at our institution between 1964 and 1979. All patients received radiotherapy and 29 patients had radical neck dissection (RND) or total excisional biopsy (TEB) as well. Actuarial survival was 38% at 5 years for the entire group and 25% at 10 years. Fifty-four patients with neck control had significantly better survival (p = .0001) at 5 and 10 years than those whose neck was uncontrolled. Factors associated with improved neck control were initial size of the neck mass and the addition of surgery (RND or TEB). Analysis of failures showed that 50% of patients failed only in the primary or neck and 50% developed distant metastases. Tumor was the major cause of death. We recommend more aggressive treatment with both XRT and neck dissection in patients with large resectable neck masses to prevent regrowth of tumor in the neck.