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Carcinoma Metastatic to Cervical Lymph Nodes From an Occult Primary Tumor: The Outcome After Combined-Modality Therapy

¹ ENT Department and Regional Center for Head and Neck Cancer, University of Padua, School of Medicine, Treviso Regional Hospital, Treviso, Italy
² Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy

Correspondence: Address correspondence and reprint requests to: Paolo Boscolo-Rizzo, MD; Viale Umbria 6, IT-30019 Chioggia (Venezia) Italy; E-mail: paolo.boscolorizzo{at}unipd.it

Background: The aim of this retrospective analysis was to analyze the results of treatment of patients with cervical node metastases from carcinoma of occult primary with a policy including neck dissection and postoperative comprehensive radiotherapy.

Methods: Ninety patients were treated with curative intent from 1990 to 2002.

Results: The actuarial rate of neck disease control was 68.8% at 5 years (95% confidence interval [CI], 58.9%–78.7%). On multivariate analysis, the rate of neck disease control was significantly related to lymph nodal metastatic level (P = .006). The actuarial rate of developing head and neck primary tumors at 5 years was 8.9% (95% CI, 2.6%–15.2%). The 5-year actuarial rate of distant metastases was 19.1% (95% CI, 9.4%–28.9%). In multivariate analysis, a statistically significant difference in the rate of distant metastasis was obtained when patients were stratified according to the level of nodal involvement (P = .01) and the presence of extracapsular extension (P = .013). At the time of analysis, 50 of the 90 patients were alive. A total of 32 (35.6%) had died from causes related to their primary disease. Actuarial disease-specific survival at 2 and 5 years was 73.6% (95% CI, 64.3%–82.9%) and 62.8% (95% CI, 51.9%–73.7%), respectively. In multivariate analysis, a statistically significant difference in disease-specific survival was obtained when patients were stratified according to the level of nodal involvement and the presence of extracapsular extension.

Conclusions: Our study seems to support the use of combined-modality therapy in patients with neck metastases from carcinoma of occult primary. However, in the absence of randomized trials, comprehensive irradiation cannot be routinely advised.

Key Words: Occult primary • unknown primary • head and neck cancer • treatment • radiotherapy • neck dissection