Mackenzie K, Watson M, Jankowska P, Bhide S, Simo R
University of Strathclyde,Glasgow,UK.
ENT Department,Doncaster Royal Infirmary,Doncaster,UK.
J Laryngol Otol. 2016 May;130(S2):S170-S175. doi: 10.1017/S0022215116000591.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the evidence base pertaining to the management of metastatic neck disease in the setting of an unknown primary and provides recommendations on the work up and management for this group of patients receiving cancer care. Recommendations • All patients presenting with confirmed cervical lymph node metastatic squamous cell carcinoma and no apparent primary site should undergo: ○ Positron emission tomography-computed tomography whole-body scan. (R) ○ Panendoscopy and directed biopsies. (R) ○ Bilateral tonsillectomy. (R) • Tongue base mucosectomy can be offered if facilities and expertise exists. (G) • Concomitant chemotherapy with radiation should be considered in patients with an unknown primary. (R) • Concomitant chemotherapy with radiation should be offered to suitable patients in the post-operative setting, where indicated. (R) • Neo-adjuvant chemotherapy can be used in gross 'unresectable' disease. (R) • Patients should be followed up at least two months in the first two years and three to six months in the subsequent years. (G) • Patients should be followed up to a minimum of five years with a prolonged follow up for selected patients. (G) • Positron emission tomography-computed tomography scan at three to four months after treatment is a useful follow-up strategy for patients treated by chemoradiation therapy. (R).
这是英国参与头颈癌患者护理的专业协会认可的官方指南。它讨论了在原发灶不明情况下转移性颈部疾病管理的证据基础，并为这组接受癌症护理的患者的检查和管理提供建议。
建议
• 所有出现确诊的颈部淋巴结转移性鳞状细胞癌且无明显原发部位的患者应接受：
正电子发射断层扫描-计算机断层扫描全身扫描。（推荐）
全腔镜检查及定向活检。（推荐）
双侧扁桃体切除术。（推荐）
• 若有条件和专业技术，可提供舌根黏膜切除术。（一般建议）
• 对于原发灶不明的患者，应考虑同步放化疗。（推荐）
• 在术后有指征的情况下，应向合适的患者提供同步放化疗。（推荐）
• 新辅助化疗可用于大体“不可切除”的疾病。（推荐）
• 患者在头两年应至少每两个月随访一次，后续年份每三至六个月随访一次。（一般建议）
• 患者应至少随访五年，部分患者应延长随访时间。（一般建议）
• 对于接受放化疗的患者，治疗后三至四个月进行正电子发射断层扫描-计算机断层扫描是一种有用的随访策略。（推荐）
