Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2009; 30(04): 124-130
DOI: 10.4103/0971-5851.65334
ORIGINAL ARTICLE

Metastatic squamous cell carcinoma neck with occult primary: A retrospective analysis

Pragya Shukla
Department of Radiation Oncology, TATA Memorial Cancer Hospital, Mumbai, India
,
Deepak Gupta
Department of Radiation Oncology, TATA Memorial Cancer Hospital, Mumbai, India
,
Shyam Singh Bisht
Department of Radiation Oncology, Medicity Gurgaon, India
,
Mohan Chand Pant
Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh - 226 000, India
,
Madan Lal Bhatt
Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh - 226 000, India
,
Kirti Srivastava
Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh - 226 000, India
,
Mahendra Pal Singh Negi
Department of Biostats, Central Drug Research Institute, Lucknow, India
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

Introduction:Metastatic carcinoma in the lymph nodes of the neck from an unknown primary is relatively rare, accounting for about 3% of all head and neck cancers. Management of secondary neck of undetermined primary is controversial.Materials and Methods:The case records of all the patients treated in the Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, from Oct 1999 to Sep 2004, were studied and the patients with secondary neck without a known primary tumor were analyzed in detail to elucidate the outcome of various treatment modalities in various stages of the disease. One hundred and forty patients were found to be eligible for this analysis. Initial treatment could be divided into two categories: concurrent chemoradiation (n=76) and radiotherapy alone (n=64).Results:The patients who had received radiotherapy alone (53.1%) had lesser complete response as compared to those who had received chemoradiotherapy (68.4%). The overall survival duration in patients of the radiotherapy treatment group ranged from 5 to 60 months, with an average (±SD) of 31.06 ± 21.01 months, while in the chemoradiotherapy treatment group it ranged from 6 to 60 months, with an average (±SD) of 39.42 ± 21.33 months. Both hematological and nonhematological toxicities, although higher in the chemoradiotherapy group, showed statistically insignificant differences.Conclusion:To the best of our knowledge, this is the only study evaluating the role of concurrent chemoradiation in cases of secondary neck with primary unknown. The improved response rates along with an increased survival (both disease free and overall) show the superiority of chemoradiotherapy in the management of such cases.

Keywords

Chemoradiotherapy - head and neck - metastatic cervical lymph node - radiotherapy - unknown primary


Publication History

Article published online:
19 November 2021

© 2009. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Martin H, Morfit HM. Cervical lymph node metastasis as the first symptom of cancer. Surg Gynecol Obstet 1944;78:133-9.
  • 2 Richard JM, Micheau C. Malignant cervical adenopathies from carcinomas of unknown origin. Tumori 1977;63:249-58.
  • 3 Nordstrom DG, Tewfik HH, Latourette HB. Cervical lymph node metastases from an unknown primary. Int J Radiat Oncol Biol Phys 1979;5:73-6.
  • 4 Fried MP, Diehl WH Jr, Brownson RJ, Sessions DG, Ogura JH. Cervical metastasis from an unknown primary. Ann Otol Rhinol Laryngol 1975;84:152-7.
  • 5 Colletier PJ, Garden AS, Morrison WH, Goepfert H, Geara F, Ang KK. Postoperative radiation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site: Outcomes and patterns of failure. Head Neck 1998;20:674-81.
  • 6 Coster JR, Foote RL, Olsen KD, Jack SM, Schaid DJ, DeSanto LW. Cervical nodal metastasis of squamous cell carcinoma of unknown origin: Indications for withholding radiation therapy. Int J Radiat Oncol Biol Phys 1992;23:743-9.
  • 7 Davidson BJ, Spiro RH, Patel S, Patel K, Shah JP. Cervical metastases of occult origin: The impact of combined modality therapy. Am J Surg 1994;168:395-9.
  • 8 Harper CS, Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Million RR. Cancer in neck nodes with unknown primary site: Role of mucosal radiotherapy. Head Neck 1990;12:463-9.
  • 9 Wang RC, Goepfert H, Barber AE, Wolf P. Unknown primary squamous cell carcinoma metastatic to the neck. Arch Otolaryngol Head Neck Surg 1990;116:1388-93.
  • 10 Jones AS, Cook JA, Phillips DE, Roland NR. Squamous carcinoma presenting as an enlarged cervical lymph node. Cancer 1993;72:1756-61.
  • 11 Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998;20:739-44.
  • 12 Safa AA, Tran LM, Rege S, Brown CV, Mandelkern MA, Wang MB, et al. The role of positron emission tomography in occult primary head and neck cancers. Cancer J Sci Am 1999;5:214-8.
  • 13 Bataini JP, Rodriguez J, Jaulerry C, Brugere J, Ghossein NA. Treatment of metastatic neck nodes secondary to an occult epidermoid carcinoma of the head and neck. Laryngoscope 1987;97:1080-4.
  • 14 Carlson LS, Fletcher GH, Oswald MJ. Guidelines for radiotherapeutic techniques for cervical metastases from an unknown primary. Int J Radiat Oncol Biol Phys 1986;12:2101-10.
  • 15 Lefebvre JL, Coche-Dequeant B, Van JT, Buisset E, Adenis A. Cervical lymph nodes from an unknown primary tumor in 190 patients. Am J Surg 1990;160:443-6.
  • 16 McCunniff AJ, Raben M. Metastatic carcinoma of the neck from an unknown primary. Int J Radiat Oncol Biol Phys 1986;12:1849-52.
  • 17 Reddy SP, Marks JE. 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 1997;37:797-802.
  • 18 Weir L, Keane T, Cummings B, Goodman P, O′Sullivan B, Payne D, et al. Radiation treatment of cervical lymph node metastases from an unknown primary: An analysis of outcome by treatment volume and other prognostic factors. Radiother Oncol 1995;35:206-11.
  • 19 Freeman D, Mendenhall WM, Parsons JT, Million RR. Unknown primary squamous cell carcinoma of the head and neck: Is mucosal irradiation necessary? Int J Radiat Oncol Biol Phys 1992;23:889-90.
  • 20 Fletcher GH, Jesse RH, Lindberg RD, Westbrook KC. Neck nodes. 3 rd ed. Textbook of Radiotherapy. In: Fletcher GH, editor. Philadelphia: Lea and Febiger; 1980. p. 249-71.
  • 21 Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection. Int J Radiat Oncol Biol Phys 2001;50:55-63.
  • 22 Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head and neck mucosal site treated with radiation therapy with palliative intent. Radiother Oncol 2001;59:319-21.
  • 23 Sinnathamby K, Peters LJ, Laidlaw C, Hughes PG. The occult head and neck primary: To treat or not to treat? Clin Oncol (R Coll Radiol) 1997;9:322-9.
  • 24 Beldμ D, Jereczek-Fossa BA, D′Onofrio A, Gambaro G, Fiore MR, Pia F, et al. 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 2007;69:1051-8.
  • 25 Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000;55:121-9.
  • 26 Mintzer DM, Warhol M, Martin AM, Greene G. Cancer of unknown primary: Changing approaches. A multidisciplinary case presentation from the Joan Karnell cancer center of pennsylvania hospital. Oncologist 2004;9:330-8.
  • 27 Haas I, Hoffmann TK, Engers R, Ganzer U. Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol 2002;259:325-33.
  • 28 Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev 2004;30:153-64.
  • 29 Nieder C, Gregoire V, Ang KK. Cervical lymph node metastases from occult squamous cell carcinoma: Cut down a tree to get an apple? Int J Radiat Oncol Biol Phys 2001;50:727-33.
  • 30 Kirschner MJ, Fietkau R, Waldfahrer F, Iro H, Sauer R. Therapy of cervical lymph node metastases of unknown primary tumour. Strahlenther Onkol 1997;173:362-8.
  • 31 Tong CC, Luk MY, Chow SM, Ngan KC, Lau WH. Cervical nodal metastases from occult primary: Undifferentiated carcinoma versus squamous cell carcinoma. Head Neck 2002;24:361-9.
  • 32 Fernandez JA, Suarez C, Martinez JA, Llorente JL, Rodrigo JP, Alvarez JC. Metastatic squmaous cell carcinoma in cervical lymph nodes from an unknown primary tumour: Prognostic factors. Clin Otolaryngol Allied Sci 1998;23:158-63.
  • 33 Klop WM, Balm AJ, Keus RB, Hilgers FJ, Tan IB. Diagnosis and treatment of 39 patients with cervical lymph node metastases of squmaous cell carcinoma of unknown origin, referred to Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, 1979-98. Ned Tijdschr Geneeskd 2000;144:1355-60.
  • 34 Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998;338:1798-804.
  • 35 Merlano M, Benasso M, Corvς R, Rosso R, Vitale V, Blengio F, et al. Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 1996;88:583-9.
  • 36 Weissler MC, Melin S, Sailer SL, Qaqish BF, Rosenman JG, Pillsbury HC 3 rd . Simultaneous chemoradiation in the treatment of advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 1992;118:806-10.
  • 37 Wendt CD, Peters LJ, Ang KK, Morrison WH, Maor MH, Goepfert H, et al. Hyperfractionated radiotherapy in the treatment of squamous cell carcinomas of the supraglottic larynx. Int J Radiat Oncol Biol Phys 1989;17:1057-62.
  • 38 Pignon JP, Bourhis J, Domenge C, Designι L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: Three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000;355:949-55.
  • 39 Jeremic B, Zivic L, Jevremovic S. Radiotherapy and cisplatin in metastatic squamous cell carcinoma of an unknown primary tumor localized to the neck. A phase II study. J Chemother 1992;4:399-402.
  • 40 Sobin LH, Wittekind CH, editors UICC TNM Classification of Malignant Tumors, 6 th ed. New York: Wiley-Liss; 2002.
  • 41 Strojan P, Anicin A. Combined surgery and postoperative radiotherapy for cervical lymph node metastases from an unknown primary tumour. Radiother Oncol 1998;49:33-40.
  • 42 Medini E, Medini AM, Lee CK, Gapany M, Levitt SH. The management of metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary. Am J Clin Oncol 1998;21:121-5.