Wang S J, Wang M B, Calcaterra T C
Department of Surgery, University of California at Los Angeles School of Medicine, 90095, USA.
Ann Otol Rhinol Laryngol. 1999 Feb;108(2):128-31. doi: 10.1177/000348949910800204.
Patients with small or occult primary carcinomas of the head and neck with advanced cervical metastases present a difficult problem for the otolaryngologist. A retrospective review was performed of patients who presented to UCLA Medical Center between January 1986 and June 1996 with small or occult primary tumors of the head and neck with advanced cervical metastases. The treatment algorithm consisted of initial radiotherapy to the primary site and the neck, followed in 6 to 8 weeks with endoscopy and biopsy of the primary tumor site. As long as the repeat biopsy of the primary tumor site was negative by frozen section, an immediate neck dissection was performed, even if no residual neck disease was present. Almost 40% of patients with no clinical evidence of neck disease following radiotherapy had evidence of metastatic cancer on histopathologic examination. While some would consider a watchful waiting policy when there is no clinically detectable neck disease following radiotherapy, we believe it is preferable to perform immediate surgery in such patients, in light of the high incidence of microscopic metastatic disease.
患有头颈部微小或隐匿性原发性癌且伴有晚期颈部转移的患者给耳鼻喉科医生带来了难题。对1986年1月至1996年6月期间就诊于加州大学洛杉矶分校医学中心的患有头颈部微小或隐匿性原发性肿瘤且伴有晚期颈部转移的患者进行了回顾性研究。治疗方案包括对原发部位和颈部进行初始放疗，6至8周后对原发肿瘤部位进行内镜检查和活检。只要原发肿瘤部位的重复活检冷冻切片结果为阴性，即使颈部没有残留疾病，也立即进行颈部清扫术。放疗后无颈部疾病临床证据的患者中，近40%在组织病理学检查中有转移癌证据。虽然有些人会考虑在放疗后没有临床可检测到的颈部疾病时采取观察等待策略，但鉴于微小转移疾病的高发生率，我们认为对这类患者立即进行手术更为可取。
