Skip to main content

Advertisement

SpringerLink
Log in

Squamous cell carcinoma of unknown primary tumor metastatic to neck nodes: role of elective irradiation

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

In patients with squamous cell carcinoma (SCC) metastases to neck lymph nodes and unknown primary tumor, the role of elective irradiation of uninvolved neck and potential mucosal primary sites is yet to be determined. The aim of this study was to review the experience treating SCC of unknown primary metastatic to neck nodes with surgery and postoperative radiotherapy (PORT) in Slovenia between 1995 and 2010 and to determine the importance of the extent of irradiated volume. For this purpose, the nationwide Cancer Registry of Slovenia database was used for identifying patients. 126 patients were identified. Involved-field PORT and extended-field PORT was used in 50 and 76 patients, respectively. At 5 years, locoregional control was 86 %, disease-specific survival 77 %, and overall survival 57 %. In multivariate analysis, the extent of irradiated volume has not been predictive for any outcome under study. Grade ≥3 acute and late radiotherapy-induced toxicities were more frequent in the extended-field PORT group. In conclusion, although not superior, involved-field PORT seems to be a preferred treatment option in SCC of unknown primary metastatic to neck nodes due to significantly reduced toxicity and better prospects for successful salvage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pavlidis N, Briasoulis E, Hainsworth J, Greco FA (2003) Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 39:1990–2005

    Article  CAS  PubMed  Google Scholar 

  2. Hemminki K, Bevier M, Hemminki A, Sundquist J (2012) Survival in cancer of unknown primary site: population-based analysis by site and histology. Ann Oncol 23:1854–1863

    Article  CAS  PubMed  Google Scholar 

  3. Balaker AE, Abemayor E, Elashoff D, St. John MA (2012) Cancer of unknown primary: does treatment modality make a difference? Laryngoscope 122:1279–1282

    Article  PubMed  Google Scholar 

  4. Strojan P, Aničin A (1998) Combined surgery and postoperative radiotherapy for cervical lymph node metastases from an unknown primary tumour. Radiother Oncol 49:33–40

    Article  CAS  PubMed  Google Scholar 

  5. Primic Žakelj M, Bračko M, Hočevar M et al (eds) (2013) Cancer in Slovenia 2010. Institute of Oncology Ljubljana & Epidemiology and Cancer Registry & Cancer Registry of Republic of Slovenia, Ljubljana

  6. Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB (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 55:121–129

    Article  CAS  PubMed  Google Scholar 

  7. Strojan P, Ferlito A, Medina JE et al (2013) Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches. Head Neck 35:123–132

    Article  PubMed  Google Scholar 

  8. Strojan P, Ferlito A, Langendijk JA et al (2013) Contemporary management of lymph node metastases from an unknown primary to the neck: II. A review of therapeutic options. Head Neck 35:286–293

    Article  PubMed  Google Scholar 

  9. 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

    Article  CAS  Google Scholar 

  10. Jereczek-Fossa BA, Jassem J, Orecchia R (2004) Cervical lymph node metastases of squamous cell carcinoma of unknown primary. Cancer Treat Rev 30:153–164

    Article  PubMed  Google Scholar 

  11. Perkins SM, Spencer CR, Chernock RD et al (2012) Radiotherapeutic management of cervical lymph node metastases from an unknown primary site. Arch Otolaryngol Head Neck Surg 138:656–661

    Article  PubMed  Google Scholar 

  12. Cizmarevic B, Lanisnik B, Dinevski D (2012) Cervical lymph node metastasis of squamous cell carcinoma from unknown primary tumor. Coll Antropol 36(Suppl 2):27–32

    PubMed  Google Scholar 

  13. Majchrzak E, Cholewiński W, Golusiński W (2015) Carcinoma of unknown primary in the head and neck: The evaluation of the effectiveness of (18)F-FDG-PET/CT, own experience. Rep Pract Oncol Radiother 20:393–397

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cianchetti M, Mancuso AA, Amdur RJ et al (2009) Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope 119:2348–2354

    Article  PubMed  Google Scholar 

  15. Expert Panel on Radiation Oncology—Head & Neck Cancer: Yeung AR, Garg MK, Lawson J et al; American College of Radiology (2012) ACR Appropriateness Criteria® ipsilateral radiation for squamous cell carcinoma of the tonsil. Head Neck 34:613–616

  16. Ligey A, Gentil J, Créhange 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 93:483–487

    Article  CAS  PubMed  Google Scholar 

  17. Wallace A, Richards GM, Harari PM et al (2011) Head and neck squamous cell carcinoma from unknown primary site. Am J Otolaryngol 32:286–290

  18. Haigentz M Jr, Cohen EE, Wolf GT, Strojan P, Eisbruch A, Ferlito A (2012) Oral Oncol 48:1065–1067

    Article  PubMed  Google Scholar 

  19. Jensen DH, Hedback N, Specht L et al (2014) Human papillomavirus in head and neck squamous cell carcinoma of unknown primary is a common event and a strong predictor of survival. PLoS One 9:e110456

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sivars L, Näsman A, Tertipis N et al (2014) Human papillomavirus and p53 expression in cancer of unknown primary in the head and neck region in relation to clinical outcome. Cancer Med 3:376–384

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Park GC, Jung JH, Roh JL et al (2014) Prognostic value of metastatic nodal volume and lymph node ratio in patients with cervical lymph node metastases from an unknown primary tumor. Oncology 86:170–176

    Article  CAS  PubMed  Google Scholar 

  22. Keller LM, Galloway TJ, Holdbrook T et al (2014) p16 status, pathologic and clinical characteristics, biomolecular signature, and long-term outcomes in head and neck squamous cell carcinomas of unknown primary. Head Neck 36:1677–1684

    Article  PubMed  PubMed Central  Google Scholar 

  23. Graboyes EM, Sinha P, Thorstad WL, Rich JT, Haughey BH (2015) Management of human papillomavirus-related unknown primaries of the head and neck with a transoral surgical approach. Head Neck 37:1603–1611

    Article  PubMed  Google Scholar 

  24. Nagel TH, Hinni ML, Hayden RE, Lott DG (2014) Transoral laser microsurgery for the unknown primary: role for lingual tonsillectomy. Head Neck 36:942–946

    Article  PubMed  Google Scholar 

  25. Mehta V, Johnson P, Tassler A et al (2013) A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope 123:146–151

    Article  PubMed  Google Scholar 

  26. Ang KK, Harris J, Wheeler R et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24–35

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Strojan P, Zadnik V, Šifrer R et al (2015) Incidence trends in head and neck squamous cell carcinoma in Slovenia, 1983–2009: role of human papillomavirus infection. Eur Arch Otorhinolaryngol 272:3805–3814

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Institute of Oncology, Zaloška 2, 1000, Ljubljana, Slovenia

    Primož Strojan, Marko Kokalj & Gaber Plavc

  2. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Primož Strojan

  3. Epidemiology and Cancer Registries, Institute of Oncology Ljubljana, Ljubljana, Slovenia

    Vesna Zadnik

  4. University Department of Otorhinolaryngology and Cervicofacial Surgery, University Clinical Center Ljubljana, Ljubljana, Slovenia

    Aleksandar Aničin & Robert Šifrer

  5. Department of Maxillofacial and Oral Surgery, University Clinical Center Ljubljana, Ljubljana, Slovenia

    Vojislav Didanović

  6. Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Clinical Center Maribor, Maribor, Slovenia

    Boštjan Lanišnik

Authors
  1. Primož Strojan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marko Kokalj
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vesna Zadnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aleksandar Aničin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gaber Plavc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vojislav Didanović
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Šifrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Boštjan Lanišnik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Primož Strojan.

Ethics declarations

Because of retrospective nature of this study, informed consent was not obtained from the (living) patients. The study protocol was approved by the Protocol Review Board of the Institute of Oncology Ljubljana (March 20, 2015; ERID-KESOPKR/46).

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Strojan, P., Kokalj, M., Zadnik, V. et al. Squamous cell carcinoma of unknown primary tumor metastatic to neck nodes: role of elective irradiation. Eur Arch Otorhinolaryngol 273, 4561–4569 (2016). https://doi.org/10.1007/s00405-016-4172-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-016-4172-5

Keywords

Search

Navigation