Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cancer. 2018 Apr 1;124(7):1415-1427. doi: 10.1002/cncr.31235. Epub 2018 Jan 16.
There are few published studies to guide the treatment of carcinoma metastatic to the neck from an unknown primary (CUP). In this regard, the objective of the current study was to share the authors' current experience treating patients with CUP using intensity-modulated radiation therapy (IMRT), which principally targeted both sides of the neck, the nasopharynx, and the oropharynx.
This was a retrospective study in which an institutional database search was conducted to identify patients with CUP who received IMRT. Data analysis included frequency tabulation, survival analysis, and multivariable analysis.
Two-hundred sixty patients met inclusion criteria. The most common lymph node category was N2b (54%). IMRT volumes included the entire pharyngolaryngeal mucosa in 78 patients, the nasopharynx and oropharynx in 167 patients, and treatment limited to the involved neck in 11 patients. Eighty-four patients underwent neck dissections. The 5-year overall survival, regional control, and distant metastases-free survival rates were 84%, 91%, and 94%, respectively. Over 40% of patients had gastrostomy tubes during therapy, and 7% patients were diagnosed with chronic radiation-associated dysphagia. Higher lymph node burden was associated with worse disease-related outcomes, and in subgroup analysis, patients with human papillomavirus-associated disease had better outcomes. No therapeutic modality was statistically associated with either disease-related outcomes or toxicity.
Comprehensive IMRT with treatment to both sides of the neck and to the oropharyngeal and nasopharyngeal mucosa results in high rates of disease control and survival. The investigators were unable to demonstrate that treatment intensification with chemotherapy or surgery added benefit or excessive toxicity. Cancer 2018;124:1415-27. © 2018 American Cancer Society.
原发灶不明的颈部转移癌（CUP）的治疗鲜有文献报道。本研究旨在介绍作者采用调强放疗（IMRT）治疗 CUP 患者的经验，该方法主要针对双侧颈部、鼻咽部和口咽部。
这是一项回顾性研究，通过机构数据库检索，确定接受 IMRT 的 CUP 患者。数据分析包括频数表分析、生存分析和多变量分析。
260 例患者符合纳入标准。最常见的淋巴结分类为 N2b（54%）。IMRT 照射野包括 78 例患者的整个咽喉黏膜、167 例患者的鼻咽部和口咽部，以及 11 例仅局限于受累颈部的照射野。84 例患者接受了颈部清扫术。5 年总生存率、区域控制率和无远处转移生存率分别为 84%、91%和 94%。超过 40%的患者在治疗过程中需要胃造口管，7%的患者被诊断为慢性放射性吞咽困难。较高的淋巴结负荷与较差的疾病相关结局相关，亚组分析显示，HPV 相关疾病患者的结局更好。没有任何治疗方式与疾病相关结局或毒性具有统计学相关性。
双侧颈部及口咽、鼻咽部的综合 IMRT 治疗可获得较高的疾病控制率和生存率。研究者未能证实化疗或手术的强化治疗可带来获益或增加毒性。癌症 2018；124：1415-27。©2018 美国癌症协会。
