Value of Neck Dissection in Patients with Squamous Cell Carcinoma of Unknown Primary

Abstract

Lymph node metastases of cancer of an unknown primary (CUP syndrome) are responsible for 3–5% of the malignant diseases in the head and neck area. More than 70% of these patients show lymph node metatases of an unknown squamous cell carcinoma. The survival depends immediately on number and location of lymph node metastases. For a curative approach modified radical neck dissection combined with postoperative radiation therapy with or without chemotherapy should be considered in N1–N3 lymph node status. A radical neck dissection with postoperative radiation therapy should only be approved in cases of infiltration of the internal jugular vein, the accessory nerve and/or the sternocleidoid muscle. The different prognosis of patients with upper cervical and lower cerival lymph nodes should influence the indication and the extent of a neck dissection in the contralateral N0 neck.

Impact of Distant Metastasis in Patients with Cervical Lymph Node Metastases from Cancer of an Unknown Primary Site

“…Supraclavicular metastasis may further be due to tumors of the ovary, mammary gland, or the gastrointestinal or urogenital tracts, and there is also the possibility of a lymph node metastasis from a clinically occult melanoma. 4 The primary goals of treatment are to eliminate the risk of nodal relapse (neck control) and to prevent the emergence of a primary site of disease (local control). Therapy strategies vary depending on the histology of the metastases, and decisions about the optimal treatment must balance the efficacy of treatment with potential toxicity.…”

Cervical lymph node metastases of unknown origin: primary tumor detection with whole-body positron emission tomography/computed tomography

“…This better prognosis of patients with cervical CUP is due to the availability of different locoregional treatment options such as radical tumor resection or effective radiation therapy (21,24,32,35,36). Major prognostic factors for patients with cervical CUP are tumor histology (22), nodal stage (9,11,15,20,34), localization of cervical lymph node metastases (19,22,35), and method of treatment (14,15,19).…”

“…This better prognosis of patients with cervical CUP is due to the availability of different locoregional treatment options such as radical tumor resection or effective radiation therapy (21,24,32,35,36). Major prognostic factors for patients with cervical CUP are tumor histology (22), nodal stage (9,11,15,20,34), localization of cervical lymph node metastases (19,22,35), and method of treatment (14,15,19). In contrast to early reports (19,22), which did not show any improvement in patient prognosis by detection of the primary tumor in cervical CUP, recent studies have demonstrated a higher 3-year survival rate for patients with CUP resulting from oropharyngeal cancer (11) and a reduced recurrence rate for patients with CUP from tonsillar carcinoma (25) if the primary tumor was identified.…”

“…In contrast to extracervical metastases of unknown origin, which have a poor prognosis with an average survival of only a few months, patients with cervical CUP have a more favorable course of disease (9,19,20,24,29,(32)(33)(34)36). This better prognosis of patients with cervical CUP is due to the availability of different locoregional treatment options such as radical tumor resection or effective radiation therapy (21,24,32,35,36). Major prognostic factors for patients with cervical CUP are tumor histology (22), nodal stage (9,11,15,20,34), localization of cervical lymph node metastases (19,22,35), and method of treatment (14,15,19).…”

Value of Neck Dissection in Patients with Cancer of the Parotid Gland and a Clinical N0 Neck

“…The analysis of p53 expression in parotid gland cancer demonstrates a significantly higher metastasis rate in tumors with a high expression of this oncoprotein [28]. For assessment of the metastatic behavior of parotid gland cancer, the knowledge of the incidence of regional occult metastases is very important, as in carcinomas in other head and neck regions [29]. High-grade cancers show a frequency of up to 50% for occult lymph node metastases, in comparison to maximally 10% for low-grade tumors [14,21,30].…”