Treatment of metastatic neck nodes secondary to an occult epidermoid carcinoma of the head and neck

Abstract

One hundred thirty-eight patients, who were followed for a minimum of 5 years, had either surgery and postoperative radiotherapy (48 patients) or radiotherapy only (90 patients) for metastatic epidermoid carcinoma in cervical nodes from an unknown head and neck primary. All received radiotherapy to the presumed occult sites. Forty-five percent presented with a single unilateral adenopathy. Those who were initially operable had a neck recurrence rate of 17% and a survival rate of 53%. Forty-three percent of initially inoperable patients recurred and only 25% survived. Patients with adenopathy which completely regressed or became resectable after irradiation had an 80% locoregional control. Only 4% developed an overt cancer at an occult site within 5 years.

Cervical Lymph Node Metastases from Occult Squamous Cell Carcinoma: Analysis of 82 Cases

“…Previous studies confi rm the multicentric area as the most common site of emergence of occult primary supporting the rule of panendoscopy, neck CT/MRI and chest CT in the diagnostic work-up [1,[3][4][5] .…”

“…The occult primary tumor is eventually found in approximately 10-40% of patients during the follow-up and the upper aerodigestive tract is the most common site [1,[3][4][5] .…”

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].…”