[Therapy pf cervical lymph node metastases of unknown primary tumor]

The primary tumor remains unknown in approximately 3 to 9% of patients with lymph node metastases in the neck. Management of these patients is still controversial particularly because of the commonly as poor assessed prognosis. The treatment outcome was surveyed by a retrospective analysis, trying to identify prognostic factors.

From 1979 through 1993, 64 patients with metastatic carcinoma of unknown primary tumor involving neck lymph nodes were treated. Most of them (n = 40) were squamous cell carcinomas. Forty-eight patients underwent surgical resection of the involved nodes by neck dissection or excisional biopsy. Surgery was performed in 41 patients before and in 7 patients after radiotherapy. Additional chemotherapy was administered to 12 patients (simultaneously to 11 patients). The irradiated volume included both sides of the neck, the supraclavicular region and the whole pharynx. The mean radiation dose was 59 Gy. In 32 patients, an additional boost to epipharynx (n = 23) and/or large lymph nodes (n = 11) was given (mean: 12 Gy) by external beam therapy, in 2 cases by interstitial implants (22 Gy). Mean follow-up time was 8 years (range: 7 months to 15 years, median: 9 years).

Fifty-two out of 64 (81.2%) patients came into a complete remission and 12 into a partial remission. The cause specific survival after 5 years for the whole group was 51.0 +/- 7%, the overall survival 38.8 +/- 7%. Within the irradiated area the tumor control was 68.3 +/- 7%, the distant metastatic-free survival 70.0 +/- 7%. Best results showed patients after surgery+radiation (n = 48) with 67% overall survival at 5 years versus 0% (median: 9.2 months) without surgery (n = 16), and patients with lymph nodes located above the glottic level (n = 49) 63.2% versus 9.0% (median: 1.2 years, n = 12). The primary tumor appeared in 9 patients (4 times above the clavicles), once in the irradiated volume.

Patients with cervical metastases of unknown primaries do not fare worse than patients with advanced carcinoma of head and neck and should be treated with a curative intent preferably by surgery and radiotherapy.