Christiansen Hans, Hermann Robert Michael, Martin Alexios, Nitsche Mirko, Schmidberger Heinz, Pradier Olivier
Department of Radiotherapy and Radiooncology, University of Göttingen, Germany.
Strahlenther Onkol. 2005 Jun;181(6):355-62. doi: 10.1007/s00066-005-1338-2.
Up to 10% of all neck lymph node metastases present without a known primary site. The optimal treatment strategy for these patients is still undefined. The purpose of this retrospective analysis is to assess the outcome in patients with neck metastases from an unknown primary tumor (CUP). Furthermore, prognostic factors and treatment modalities are discussed.
From 1984 to 2003, 28 patients with squamous cell neck metastases from a CUP were treated at the authors' institution. In 17 patients, neck dissection (twelve radical, five modified radical) was performed. In that case, adjuvant radiotherapy was carried out with a mean of 56.7 Gy. In eleven patients, only biopsies were done. These patients received definitive radiotherapy with a mean of 66.8 Gy. In summary, 25 patients received extended radiotherapy including both sides of the neck and potential mucosal primary sites. Additional chemotherapy was administered to five patients.
The duration of follow-up was 4.1-189.5 months (median 45.1 months). After this period of time, ten patients (36%) remained alive. 5-year overall survival was 40.1%, neck control rate 72.7%. No subsequent primary could be detected. Extracapsular extension and surgery had significant influence on prognosis. Grade 3 toxicity (mucositis or skin reactions) was seen in three patients; no hematologic toxicity > grade 2 was observed. 19 patients suffered from grade 2 xerostomia.
With radical surgery followed by radiotherapy good survival rates in patients with neck metastases from a CUP can be obtained. Whether limited radiotherapy might be equal to extended irradiation and can reduce side effects, must be shown in ongoing clinical trials.
所有颈部淋巴结转移患者中，高达10%的患者找不到已知的原发部位。这些患者的最佳治疗策略仍不明确。本回顾性分析的目的是评估不明原发肿瘤（CUP）颈部转移患者的治疗结果。此外，还讨论了预后因素和治疗方式。
1984年至2003年，作者所在机构共治疗了28例CUP颈部鳞状细胞转移患者。17例患者接受了颈部清扫术（12例根治性，5例改良根治性）。在这种情况下，辅助放疗的平均剂量为56.7 Gy。11例患者仅进行了活检。这些患者接受了平均剂量为66.8 Gy的根治性放疗。总之，25例患者接受了包括双侧颈部和潜在黏膜原发部位的扩大放疗。5例患者接受了额外的化疗。
随访时间为4.1 - 189.5个月（中位时间45.1个月）。在此期间后，10例患者（36%）仍存活。5年总生存率为40.1%，颈部控制率为72.7%。未发现后续原发肿瘤。包膜外侵犯和手术对预后有显著影响。3例患者出现3级毒性反应（黏膜炎或皮肤反应）；未观察到血液学毒性>2级的情况。19例患者患有2级口干症。
对于CUP颈部转移患者，采用根治性手术联合放疗可获得较好的生存率。有限放疗是否等同于扩大照射并能减少副作用，必须在正在进行的临床试验中得到证实。
