Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: Results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation

Induction Chemotherapy Followed by Radiotherapy in Patients with Cervical Lymph Node Metastases from Unknown Primary Carcinoma

“…The main goal of the present study, therefore, was to review the outcomes and toxicities of induction chemotherapy and radiotherapy for patients with UPC treated with curative intent at our center. For UPC patients with the unfavorable factors include higher neck stage, extracapsular invasion, advanced stage and the presence of recurrent or residual disease after primary treatment, advanced stage, chemotherapy and radiotherapy plays a major role [8,9]. Combined modality treatment with concurrent chemotherapy and RT was shown to significantly improve the outcomes of those with locally advanced headand-neck cancer [10][11][12][13].…”

“…If a response was recognized (complete response, CR or partial response, PR), then they received one more course of chemotherapy before undergoing the radiotherapy. Dose adjustments were permitted for both drugs according to the specific toxicities as noted in previous studies [7][8][9]. Colony stimulating factor was given for treating patients with grade 4 neutropenia or febrile neutropenia, for which there was a 25 % subsequent dose reduction of both drugs.…”

Accuracy of Diagnostic Methods for Detection of Head and Neck Primary Origin in Metastatic Neck Mass

“…In early-stage neck disease, monomodal therapy is possible, whereas an advanced-stage neck disease usually requires an aggressive multimodal approach, comparable to locally advanced head and neck cancer [83]. Table 2 summarizes larger studies on HNCUP-therapy, including nodal stages of the patients treated, treatment modalities, radiotherapy and surgery specifications and finally control rates and survival data [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…However, when RT was postponed and used for salvage treatment only, ultimate control above the clavicles still reached more than 90% in pN1 situations without ECE [84]. Surgery should also be followed by adjuvant RT in cases of connective tissue invasion (ECE), more than one involved node and a likelihood of residual Abbrevations: UC undifferentiated carcinoma, AC adenocarcinoma, EC epidermoid carcinoma, GCSO glandular carcinoma of salavary origin, IB incision biopsy, CB core biopsy, EB exicision biospy, ND neck dissection, MND modified neck dissection, RND radical neck dissection, pts patients, dRT definitive radiotherapy, pRT postoperative radiotherapy, LRFS locoregional relapse-free survival, NS not specified; *median dose in the 1980s, **median dose in the 1990s; TNM staging referring to UICC/AJCC classification actual when published; Tumor entity SCC if not described otherwise; adapted from references [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] microscopic disease in the neck (R1) [87,88]. In cases without these risk factors postoperative RT could be considered.…”

“…The estimated occurrence of CUP in the head and neck (HNCUP) region varies between 3 and 9%, with histological findings of a squamous cell malignancy in 53-77% of the cases [6][7][8]. The frequency of a subsequent mucosal emergence of the primary site in the head and neck region varies between 4 and 21% percent in the studies reviewed [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The most frequently encountered primary symptom is a cervical mass due to enlarged lymph nodes (94%) [15], mostly located in level 2 (30-50%), followed by level 1 and 3 (10-20%) and 4 and 5 (5-10%) [2,15].…”