Role of Radiotherapy in the Treatment of Cervical Lymph Node Metastases From an Unknown Primary Site: Retrospective Analysis of 113 Patients

Beldì, Debora; Jereczek-Fossa, Barbara A.; d’Onofrio, Alberto; Gambaro, G.; Fiore, Maria Rosaria; Pia, Francesco; Chiesa, Fausto; Orecchia, Roberto; Krengli, Marco

doi:10.1016/j.ijrobp.2007.04.039

Cited by 69 publications

(86 citation statements)

References 28 publications

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“…The majority of authors recommend surgical removal of the neck disease, followed by comprehensive postoperative radiotherapy (5,(30)(31)(32). Surgery alone is not recommended, except for patients with pN1 or N2a neck disease in level I, with no extracapsular extension.…”

Section: Treatmentmentioning

confidence: 99%

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Zhuang

et al. 2014

Molecular and Clinical Oncology

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Abstract. Cancer of unknown primary site (CUP) is an intriguing clinical phenomenon found in ~3-9% of all head and neck cancers. It has not yet been determined whether CUP forms a distinct biological entity with specific genetic and phenotypic characteristics, or whether it is the clinical presentation of metastasis in patients with an undetected primary tumor and no visible clinical signs. The treatment of patients with cervical lymph node metastases from CUP remains controversial, due to the lack of randomized clinical trials comparing different treatment options. Consequently, treatment is currently based on non-randomized data and institutional policy. In the present review, the range and limitations of diagnostic procedures are summarized and an optimal diagnostic work-up is recommended. The initial preferred diagnostic procedures include fine-needle aspiration biopsy (FNAB) and imaging. Although neck dissection followed by postoperative radiotherapy is the the most generally accepted approach, other curative options may be used in certain patients, such as neck dissection alone, nodal excision followed by postoperative radiotherapy, or radiotherapy alone. There remains controversy regarding target radiation volumes, ranging from ipsilateral neck irradiation to prophylactic irradiation of all the potential mucosal sites and both sides of the neck. When no primary lesion is identified with imaging and endoscopy in patients without history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus and/or Epstein-Barr virus is required.

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Section: Treatmentmentioning

confidence: 99%

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Zhuang

et al. 2014

Molecular and Clinical Oncology

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“…It is estimated that primary location is not found in approximately 1-2% newly diagnosed head and neck metastatic tumors and a PET/CT examination may considerably contribute to their identification [25][26][27]. In our case, PET/CT located all 3 cases of primary tumors unidentified by conventional diagnostic methods.…”

Section: Discussionmentioning

confidence: 60%

PET/CT significance for planning radiotherapy of head and neck cancer

Kolářová¹,

Vaňásek²,

Kandrnal³

et al. 2012

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The combination of positron emission tomography and computed tomography (PET/CT) offers metabolic mapping in addition to anatomic information of the primary lesion, nodal and distant metastases in patients with head and neck tumors, and may be therefore beneficial for radiotherapy planning. The aim of our study was to evaluate benefits of combined PET and CT imaging for staging and target volume delineation in this group of patients.Fifty three patients (40 men and 13 women) with confirmed advanced, inoperable or non-radically operated head and neck cancer were assessed based on the results of PET/CT as well as standard diagnostic examinations. All patients were subsequently treated with intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) of 6 MV X-rays.There was an agreement between the standard examinations results and results of PET/CT in 30 cases. In 23 cases there was disagreement either in tumor size, nodal involvement or presence of distant metastases. Results of the tumor size assessment differed significantly in 5 cases. There was no agreement found in nodal involvement in 10 cases. The cancer confirmed by standard examination was not found by PET/CT in 2 cases; 3 PET/CT positive findings were not confirmed by standard examinations. In 3 patients PET-CT revealed new distant metastatic disease. Based on PET/CT assessment we changed treatment strategy and applied potentially curative dose of radiotherapy to previously undiscovered regions in 9 patients. We decided to change the treatment intent in 3 cases and only palliative treatment was applied. Based on our experience and the literature review, PET/CT may be considerable contribution to the standard diagnostic procedures in approximately one third of cases.

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“…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].…”

Section: Therapeutic Optionsmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Kim¹,

Yoon²,

Kim³

et al. 2017

Korean J Otorhinolaryngol-Head Neck Surg

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Role of Radiotherapy in the Treatment of Cervical Lymph Node Metastases From an Unknown Primary Site: Retrospective Analysis of 113 Patients

Cited by 69 publications

References 28 publications

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

PET/CT significance for planning radiotherapy of head and neck cancer

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

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