Squamous cell carcinoma metastatic to cervical lymph nodes from unknown primary origin: the impact of chemoradiotherapy

Abstract

The management of cervical lymph node metastases of squamous cell carcinoma from an unknown primary site is still a therapeutic challenge. We report here our experience in treating these patients with chemoradiotherapy as a curative approach. Data from 40 patients were reviewed. In total, 20 (50%) patients underwent excisional biopsy. All patients underwent radiotherapy, which was delivered to both sides of the neck and pharyngeal mucosa (extensive field), and concurrent chemotherapy consisting of weekly cisplatin at a dose of 40 mg/m2. The clinical stage of the cervical nodes at presentation was N1 in 25%, N2 in 60%, and N3 in 15%. Most patients (75%) developed at least grade 3 mucositis. Eight patients (20%) had grade 3 xerostomia and 18 patients (45%) required esophageal dilation for stricture. The 5-year overall survival (OS) rate of all patients was 67.5%. The 5-year OS rates of patients with N1, N2, and N3 lesions were 100%, 67%, and 41%, respectively (P = 0.046). The 5-year progression-free survival rate was 62.5%. In multivariate analysis, only N stage significantly affected OS (P = 0.022). Emergence of the occult primary was very limited (1 patient only). Our results suggest that extensive irradiation of both sides of the neck and pharyngeal mucosa with concurrent chemotherapy results in a lower emergence of primary tumor. Because the survival of patients with unknown primary is comparable to that of patients with known primary, an attempt at cure should always be made.

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

“…On multivariate analysis, lower N stage and ECE status was correlated with improved survival. The results are also consistent with those of previous reports (3)(4)(5)12,20,22). The current National Comprehensive Cancer Network (NCCN) guidelines for NUP (Version 1.…”

“…Some case studies have revealed therapeutic outcomes of NUP treated by radiotherapy combined with surgery and/or chemotherapy, which are summarized in Table 5 (3,6,9,11,16,17,(19)(20)(21). Prognostic factors for survival are reported to be nodal stages, number of positive nodes, neck dissection, histopathological grading and ECE (3)(4)(5)7,9,19,20,22,23). In this series, the 5-year OS rate was 58.1%, similar to the data in the previous studies.…”

“…However, the optimal treatment method for NUP still remains unclear in some respects. The extent of radiotherapy (inclusion of contralateral cervical lymph node regions and/or mucosal region) and irradiated dosage is still controversial (3)(4)(5)(6)(7)(8)(9)(10). Combination of chemotherapy has been established as the standard therapy of patients with locally advanced head and neck cancer, but the role of chemoradiotherapy for NUP has not yet been established (4,(11)(12)(13)(14)(15)(16)(17).…”

Cáncer metastásico con primario desconocido. Una revisión

“…En el grupo desfavorable, los pacientes usualmente reciben quimioterapia de forma empírica con intención paliativa, pero a pesar de esta tienen un mal pronóstico. Los subgrupos favorables son los más importantes y es a los que van dirigidos todos los esfuerzos, porque al identificarlos, recibirán un tratamiento específico, lo que mejora el pronóstico y algunos pueden tener supervivencia a largo plazo e incluso tener la posibilidad de curación (25)(26)(27)(28)(29)(30)(31)(32)(33). Entre ellos se encuentran los siguientes:…”

Stage‐directed individualized therapy in esophageal cancer

“…Caveats include heterogeneity among studies with regard to tumor type, (neo)adjuvant treatment strategies, and study design. Other studies have suggested beneficial effects of CRT with regard to survival of cervical lymph node metastases from esophageal squamous cell carcinoma . In North American and European countries, different palliative treatment strategies are widely applied for patients with cervical lymph node metastases.…”