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The report concerns 35 cases referred for radiation therapy after thorough clinical and laboratory studies failed to reveal a primary tumor site. Treatment consisted of intensive radiation therapy with 1,000 kv to a total dose of about 5,000 rads in 30 days or less. In 5 cases the diagnosis was established during life after radiation. The primary sites in these cases were in the head and neck. In 11 cases the primary tumor was determined only at autopsy. In 8 of these cases the primary site was below the level of the clavicles, mostly bronchogenic carcinoma. In 7 cases even the autopsy failed to establish the primary site. Of the remaining 12 cases with unestablished primary sites one case is still alive while 3 cases showed a pulmonary infiltrate and one showed an abdominal mass. The high incidence of primary tumors below the level of the clavicles seems to indicate that the initial treatment should be radiation therapy rather than radical surgery. This would permit continued clinical observation to determine the primary source of the metastasis while avoiding unnecessary surgery. Treatment in any event is palliative since none of the cases survived 5 years.

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