Al Kadah Basel, Papaspyrou Giorgos, Linxweiler Maximilian, Schick Bernhard, Rübe Christian, Büchler Benjamin Simeon, Niewald Marcus
Department of Otorhinolaryngology, Saarland University Medical Center, Kirrberger Straße 100, 66421, Homburg/saar, Germany.
Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/saar, Germany.
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2557-2566. doi: 10.1007/s00405-017-4525-8. Epub 2017 Mar 17.
The treatment of patients with cervical lymph node metastases without detectable primary tumor remains an important challenge, until today, no standard therapy is available. The present study investigated the multimodal treatment of patients with head and neck CUP syndrome (HNCUP) and their follow-up retrospectively. 81 patients with cervical lymph node metastases without a primary tumor were treated at the Departments of Otorhinolaryngology as well as Radiotherapy and Radiation Oncology at the University of Saarland in Homburg, Germany in the period between 1991 and 2013. All patients received routine work-up consisting of CUP panendoscopy and imaging. Neck dissection was then performed in 77% of the patients. The most common histology was squamous cell carcinoma (80%). Ten percent of the patients had distant metastases. All patients underwent primary or adjuvant radiation therapy, or simultaneous radiochemotherapy. After a median follow-up of 3.5 years, the 5-year survival rate was 30%. There was a local recurrence that was known in 20/63 patients (31%) and distant metastases were documented in 19/61 M0 patients (31%). Higher grade late toxicity (grade 3-4) was observed in 12% of patients. Neck dissection and radiation therapy remains an integral part of HNCUP therapy, while the use of chemotherapy could be considered in selected cases. Prospective multicenter randomized trials would be necessary to identify the best target volume and to clarify the role of chemotherapy.
对于无法检测到原发肿瘤的颈部淋巴结转移患者的治疗仍然是一项重大挑战，直至今日，尚无标准治疗方案。本研究回顾性调查了头颈部未知原发灶癌综合征（HNCUP）患者的多模式治疗及其随访情况。1991年至2013年期间，德国洪堡萨尔州大学耳鼻咽喉科以及放疗与放射肿瘤学系对81例无原发肿瘤的颈部淋巴结转移患者进行了治疗。所有患者均接受了包括CUP全腔镜检查和影像学检查在内的常规检查。随后，77%的患者接受了颈部清扫术。最常见的组织学类型为鳞状细胞癌（80%）。10%的患者发生了远处转移。所有患者均接受了原发或辅助放疗，或同步放化疗。中位随访3.5年后，5年生存率为30%。63例患者中有20例（31%）出现局部复发，61例M0患者中有19例（31%）记录到远处转移。12%的患者观察到3 - 4级较高等级的晚期毒性反应。颈部清扫术和放疗仍然是HNCUP治疗的重要组成部分，而在某些特定情况下可考虑使用化疗。有必要开展前瞻性多中心随机试验，以确定最佳靶区体积并阐明化疗的作用。
