Cervical lymph node metastases from cancer of unknown primary site – a retrospective analysis to diagnostic work-up and treatment methods

Cervical lymph node metastases from cancer of unknown primary site – a retrospective analysis to diagnostic work-up and treatment methods Objectives: The management of patients with cervical lymph nodes from an unknown primary is still a major challenge in oncology. No standard therapy is avaible yet. The purpose of this retrospective study was to analyze the treatment methods and the oncological follow-up of 58 patients treated for cervical CUP. Methods: The records of 58 patients, who were treated at the clinic of otorhinolaryngology of the University of Göttingen for cervical lymph nodes from cancer of unknown primary site, were retrospectively analyzed for the period between August 1986 and June 2006. Treatment consisted of neck dissection in eight patients, irradiation or chemoradiation in five patients, combined surgery and radiotherapy in 28 patients, and surgery and radiochemotherapy in 17 patients. Endpoint of the study was overall survival, disease specific survival and neck control. The data were calculated by the Kaplan-Meier method. Results: 83% of the patients were male. The average age was 56 years. Majority had a history of nicotine and alcohol consumption. The lymph node metastases were mostly presented in an advanced N-Stage. The most common histology was squamous cell carcinoma (80%). For all patients, the 3 – and 5 – year for overall survival was 52,9% and 40,9%, for disease specific survival 50,9% and 39,7% and for neck control 73,7% and 67,3%. Neck dissection followed by radiochemotherapy was associated with a higher overall survival, disease specific survival and regional control compared to patients treated by neck dissection and adjuvant radiotherapy. Extracapsular extension was a predictor to survival, but not of neck control. During the follow-up distant metastases were developed in 21 patients (36,2%) and were the most frequent cause of tumor-relates death in cases of advanced neck disease. Conclusions: Despite the fact that regional control can be achieved in many cases, survival may be limited by distant metastasis, especially in patients with advanced neck disease. Prospective multicenter randomized trials would be necessary to identify the best treatment methods.2017-05-2