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09-08-2022 | Neck Dissection | Original Article

Long-term results of radio(chemo)therapy in metastatic carcinoma to cervical lymph nodes from an unknown primary. Adult Comorbidity Evaluation 27 score as a predictor of survival

Authors: MUDr. Miloslav Pala, Ph.D., MBA, Pavla Novakova, Zdena Pechacova, Lucie Vesela, Antonin Vrana, Jarmila Sukova, Petra Holeckova, Tereza Drbohlavova, Tomas Podlesak, Lubos Petruzelka

Published in: Strahlentherapie und Onkologie | Issue 2/2023

Abstract

Purpose

To evaluate the effectiveness and toxicity of curative (chemo)radiotherapy in patients with metastatic carcinoma to cervical lymph nodes from an unknown primary.

Methods

Retrospective study of 90 consecutive patients, treated with curative radiotherapy from 2003 to 2018 (median age 59 years; current/former smokers 76%) was conducted. The distribution of nodal staging was as follows: N1: 12%, N2a: 21%, N2b: 43%, N2c: 10%, N3: 13%. In 62% of patients, neck dissection was performed before radiotherapy. Concomitant chemotherapy was given to 64% of patients.

Results

The median follow-up of surviving patients was 86 months. The median total radiotherapy dose achieved was 70 Gy. The 5‑ and 10-year locoregional control were 84% in both cases, while 5‑ and 10-year distant control were 90% and 89%, respectively. A primary tumor in the head and neck area was detected in only 2 patients. No patient had an initial failure in the pharyngeal axis or contralateral cervical nodes. The 5‑ and 10-year overall survival were 55% and 42%, respectively. Severe early toxicity occurred in 71%; severe late toxicity in 33% of patients. Multivariate analysis demonstrated N‑status (hazard ratio [HR] 2.424; 95% confidence interval [CI] 1.121–5.241; p = 0.024) and comorbidity scores assessed by ACE-27 (Adult Comorbidity Evaluation; HR 3.058; 95% CI 1.489–6.281; p = 0.002) as two independent prognostic factors for overall survival.

Conclusion

The results of our work study demonstrate the high effectiveness of curative (chemo)radiotherapy on the pharyngeal axis and bilateral cervical nodes with long-term locoregional and distant control in 3/4 of the treated patients. N‑status and comorbidity scores were shown as strong prognostic factors influencing overall survival.

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Title: Long-term results of radio(chemo)therapy in metastatic carcinoma to cervical lymph nodes from an unknown primary. Adult Comorbidity Evaluation 27 score as a predictor of survival
Authors: MUDr. Miloslav Pala, Ph.D., MBA
Pavla Novakova
Zdena Pechacova
Lucie Vesela
Antonin Vrana
Jarmila Sukova
Petra Holeckova
Tereza Drbohlavova
Tomas Podlesak
Lubos Petruzelka
Publication date: 09-08-2022
Publisher: Springer Berlin Heidelberg
Keywords: Neck Dissection
Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 2/2023
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01983-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term results of radio(chemo)therapy in metastatic carcinoma to cervical lymph nodes from an unknown primary. Adult Comorbidity Evaluation 27 score as a predictor of survival

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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