Top

Strahlentherapie und Onkologie

Published in:

01-01-2012 | Original article

Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site

A retrospective analysis*

Authors: Dr. K. Fakhrian, R. Thamm, S. Knapp, M. Molls, S. Pigorsch, B. Haller, H. Geinitz

Published in: Strahlentherapie und Onkologie | Issue 1/2012

Abstract

Purpose

The goal was to retrospectively review the outcome of patients with cervical lymph node metastases of squamuos cell carcinoma of unknown primary site (CUP) treated with radio(chemo)therapy.

Patients and methods

A total of 65 patients with CUP N1–3, M0, treated between 1988 and 2009 were evaluated: 61 patients underwent surgical resection followed by postoperative radio(chemo)therapy, 4 patients received definitive radiochemotherapy. Radiotherapy of bilateral neck nodes + the parapharyngeal region (COMP-RT) was performed in 48 patients (80%) and a unilateral radiotherapy of lymph nodes (UL-RT) in 17 patients (20%).

Results

After a median follow-up time of 64 months (range 3–219 months), the estimated 2- and 5-year overall survival (OS) rates were 71 ± 6% and 48 ± 7%, respectively. The recurrent free survival (RFS) rate at 2- and 5-years was 58 ± 6% and 48% ± 7%, respectively. Extracapsular spread, resection status (R0 vs. R1/R2), neck lymph node level (I–III vs. IV–V), and Karnofsky index (60–70 vs. 80–100) were significant prognostic factors for OS and RFS in the univariate analysis. Lower nodal stage (N1/N2a vs. N2b/N2c/N3) was significantly associated with a better OS. Resection status and involvement of lymph node level IV significantly affected the OS and RFS in the multivariate analysis. COMP-RT or concurrent chemotherapy was not associated with a better OS or RFS.

Conclusion

An advantage of comprehensive radiotherapy or radiochemotherapy compared with unilateral radiotherapy of lymph nodes was not observed.

Adelstein DJ, Li Y, Adams GL et al (2003) An Intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21:92–98PubMedCrossRef

Amdur RJ, Parsons JT, Mendenhall WM et al (1989) Postoperative irradiation for squamous cell carcinoma of the head and neck: an analysis of treatment results and complications. Int J Radiat Oncol Biol Phys 16:25–36PubMedCrossRef

Beldì D, Jereczek-Fossa BA, D’Onofrio A et al (2007) Role of radiotherapy in the treatment of cervical lymph node metastases from an unknown primary site: retrospective analysis of 113 patients. Int J Radiat Oncol Biol Phys 69:1051–1058PubMedCrossRef

Chen AM, Farwell DG, Lau DH et al (2011) Radiation therapy in the management of head-and-neck cancer of unknown primary origin. How does the addition of concurrent chemotherapy affect the therapeutic ratio. Int J Radiat Oncol Biol Phys 81:346–352PubMedCrossRef

Colletier PJ, Garden AS, Morrison WH et al (1998) Postoperative radiation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site: outcomes and patterns of failure. Head Neck 20:674–681PubMedCrossRef

Coster JR, Foote RL, Olsen KD et al (1992) Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy. Int J Radiat Oncol Biol Phys 23:743–749PubMedCrossRef

Braud F de, Heilbrun LK, Ahmed K et al (1989) Metastatic squamous cell carcinoma of an unknown primary localized to the neck. Advantages of an aggressive treatment. Cancer 64:510–515PubMedCrossRef

Dunst J, Sauer R, Weidenbecher M (1988) Halslymphknotenmetastasen bei unbekanntem Primärtumor. Strahlenther Onkol 164:129–135PubMed

Fernandez JA, Suarez C, Martinez JA et al (1998) Metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary tumour: prognostic factors. Clin Otolaryngol Allied Sci 23:158–163PubMedCrossRef

10.

Glynne-Jones RG, Anand AK, Young TE, Berry RJ (1990) Metastatic carcinoma in the cervical lymph nodes from an occult primary: a conservative approach to the role of radiotherapy. Int J Radiat Oncol Biol Phys 18:289–294PubMedCrossRef

11.

Grau C, Johansen LV, Jakobsen J et al (2000) Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 55:121–129PubMedCrossRef

12.

Hauswald H, Lindel K, Rochet N et al (2008) Surgery with complete resection improves survival in radiooncologically treated patients with cervical lymph node metastases from cancer of unknown primary. Strahlenther Onkol 184:150–156PubMedCrossRef

13.

Johansen J, Buus S, Loft A et al (2008) Prospective study of 18FDG-PET in the detection and management of patients with lymph node metastases to the neck from an unknown primary tumor. Results from the DAHANCA-13 study. Head Neck 30:471–478PubMedCrossRef

14.

Kirschner MJ, Fietkau R, Waldfahrer F et al (1997) Therapy pf cervical lymph node metastases of unknown primary tumor, (article in german). Strahlenther Onkol 173:362–368PubMedCrossRef

15.

Lammering G, De Ruysscher D, Baardwijk A van et al (2010) The use of FDG-PET to target tumors by rRadiotherapy. Strahlenther Onkol 186:471–481PubMedCrossRef

16.

Lefebvre JL, Coche-Dequeant B, Van JT et al (1990) Cervical lymph nodes from an unknown primary tumor in 190 patients. Am J Surg 160:443–446PubMedCrossRef

17.

Ligey A, Gentil J, Crehange G et al (2009) Impact of target volumes and radiation technique on loco-regional control and survival for patients with unilateral cervical lymph node metastases from an unknown primary. Radiother Oncol 93:483–487PubMedCrossRef

18.

Marcial-Vega VA, Cardenes H, Perez CA et al (1990) Cervical metastases from unknown primaries: radiotherapeutic management and appearance of subsequent primaries. Int J Radiat Oncol Biol Phys 19:919–928PubMedCrossRef

19.

Maulard C, Housset M, Brunel P et al (1992) Primary cervical lymph nodes of epidermoid type. Results of a series of 123 patients treated by the association surgery-radiotherapy or irradiation alone. Ann Otolaryngol Chir Cervicofac 109:6–13PubMed

20.

Nieder C, Gregoire V, Ang K (2001) Cervical lymph node metastases from occult squamous cell carcinoma: Cut down a tree to get an apple? Int J Radiat Oncol Biol Phys 50:727–733PubMedCrossRef

21.

Rades D, Seibold ND, Gebhard MP et al (2011) Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Strahlenther Onkol 187:626–632PubMedCrossRef

22.

Reddy SP, Marks JE (1997) Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation. Int J Radiat Oncol Biol Phys 37:797–802PubMedCrossRef

23.

Rübe C, Niewald M, Bloching M (2009) Halslymphknotenmetastasen bei unbekanntem Primärtumor. In: Bamberg M, Molls M, Sack H (eds) Radioonkologie: Klinik. 2nd edn, Munich, pp 274–280

24.

Rusthoven KE, Koshy M, Paulino AC (2004) The role of fluorodeoxyglucose positron emission tomography in cervical lymph node metastases from an unknown primary tumor. Cancer 101:2642–2649CrossRef

25.

Sinnathamby K, Peters LJ, Laidlaw C, Hughes PG (1997) The occult head and neck primary: to treat or not to treat? Clin Oncol (R Coll Radiol) 9:322–329

26.

Steinmann D, Cerny B, Karstens JH, Bremer M (2009) Chemoradiotherapy with weekly cisplatin 40 mg/m2 in 103 head-and-neck cancer patients. Strahlenther Onkol 185:682–688PubMedCrossRef

27.

Stock M, Dörr W, Stromberger C et al (2010) Investigations on parotid gland recovery after IMRT in head and neck tumor patients. Strahlenther Onkol 186:665–671PubMedCrossRef

28.

Tong CC, Luk MY, Chow SM et al (2002) Cervical nodal metastases from occult primary: undifferentiated carcinoma versus squamous cell carcinoma. Head Neck 24:361–369PubMedCrossRef

29.

Planken HJ van der, Tiwari RM, Karim AB (1997) Treatment of cervical lymph node metastasis from an unknown primary tumor, with a review of the literature. Strahlenther Onkol 173:163–169PubMedCrossRef

30.

Weir L, Keane T, Cummings B et al (1995) Radiation treatment of cervical lymph node metastases from an unknown primary: an analysis of outcome by treatment volume and other prognostic factors. Radiother Oncol 35:206–211PubMedCrossRef

31.

Wolff HA, Bosch J, Jung K et al (2010) High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer. Strahlenther Onkol 186:262–268PubMedCrossRef

32.

Wong R (2008) Current status of FDG-PET for head and neck cancer. J Surg Oncol 97:649–652PubMedCrossRef

33.

Yalin Y, Pingzhang T, Smith GI et al (2002) Management and outcome of cervical lymph node metastases of unknown primary sites: a retrospective study. Br J Oral Maxillofac Surg 40:484–487PubMedCrossRef

Title: Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site
A retrospective analysis*
Authors: Dr. K. Fakhrian
R. Thamm
S. Knapp
M. Molls
S. Pigorsch
B. Haller
H. Geinitz
Publication date: 01-01-2012
Publisher: Urban and Vogel
Published in: Strahlentherapie und Onkologie / Issue 1/2012
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-011-0017-8

2024 ASCO Annual Meeting

Springer Medicine

Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site

A retrospective analysis*

Abstract

Purpose

Patients and methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2012

Stereotactic radiotherapy in the liver hilum

Time management in radiation oncology: development and evaluation of a modular system based on the example of rectal cancer treatment

Survival of patients with head and neck cancer

Current therapy of patients with endometrial carcinoma

Mitteilungen der Fachgesellschaften

7. Ausgabe der TNM-Klassifikation: Stadienverschiebung bei 60% der Magenkarzinome verändert die prognostische Aussage