Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany.
Radiat Oncol. 2020 Apr 15;15(1):80. doi: 10.1186/s13014-020-01529-z.
To analyze management and outcomes following (chemo)radiation therapy in patients with cervical lymph node metastases from an unknown primary site (CCUP) in a large single-center cohort.
Between 2008 and 2019, 58 patients with CCUP were treated with (chemo)radiation therapy at the University of Freiburg Medical Center and were included in this analysis. Overall survival (OS), locoregional progression-free survival (PFS) and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meier method. The use of diagnostic procedures and their impact on oncological outcomes was analyzed by Cox regression, and treatment-related toxicities were quantified.
Median follow-up was 29.9 months (range 4.6-121.9). Twenty-one patients (36.2%) received definitive RT, 35 (60.3%) underwent adjuvant RT, and 2 (3.4%) were treated for oligometastatic disease. Concurrent chemotherapy was prescribed in 40 patients (69.0%). 89.6% of patients completed the prescribed RT, and 65.0% completed the prescribed simultaneous chemotherapy. Locoregional recurrence was observed in 7 patients (12.1%) and distant metastases in 13 cases (22.4%). OS was 81,1, 64.9% and 56,6% after 1, 3 and 5 years, respectively. Univariate analysis of age, gender, extracapsular spread, tumor grading, neck dissection, diagnostic utilization of F-fluorodeoxyglucose positron-emission tomography and concomitant chemotherapy showed no effect on OS (p > 0.05 for all), while smoking was significantly associated with decreased survival (p < 0.05). There was a trend towards impaired OS for patients with advanced nodal status (pN3) (p = 0.07). Three patients (5.2%) experienced grade 3 radiation dermatitis, and 12 (22.4%) developed grade 3 and 1 (1.7%) grade 4 mucositis.
RT of the panpharynx and cervical lymph nodes with concurrent chemotherapy in case of risk factors demonstrated good locoregional control, but the metachronous occurrence of distant metastases limited survival and must be further addressed.
在弗莱堡大学医学中心的一个大型单中心队列中，分析治疗原发灶不明的颈部淋巴结转移（CCUP）患者的放化疗后管理和结局。
2008 年至 2019 年期间，58 例 CCUP 患者在弗莱堡大学医学中心接受了放化疗，这些患者被纳入本分析。采用 Kaplan-Meier 法计算总生存期（OS）、局部区域无进展生存期（PFS）和无远处转移生存期（DMFS）。采用 Cox 回归分析诊断程序的应用及其对肿瘤学结局的影响，并量化治疗相关毒性。
中位随访时间为 29.9 个月（范围 4.6-121.9）。21 例患者（36.2%）接受了根治性放疗，35 例（60.3%）接受了辅助放疗，2 例（3.4%）接受了寡转移疾病的治疗。40 例患者（69.0%）接受了同期化疗。89.6%的患者完成了规定的放疗，65.0%的患者完成了规定的同期化疗。7 例（12.1%）患者出现局部区域复发，13 例（22.4%）患者出现远处转移。1、3、5 年的 OS 分别为 81.1%、64.9%和 56.6%。单因素分析显示，年龄、性别、包膜外扩散、肿瘤分级、颈清扫术、F-氟脱氧葡萄糖正电子发射断层扫描的诊断应用以及同期化疗对 OS 均无影响（所有 p 值均>0.05），而吸烟与生存率降低显著相关（p<0.05）。进展期淋巴结状态（pN3）患者 OS 受损的趋势（p=0.07）。3 例（5.2%）患者出现 3 级放射性皮炎，12 例（22.4%）出现 3 级和 1 例（1.7%）4 级黏膜炎。
对于存在危险因素的患者，采用全咽和颈部淋巴结放疗并同期化疗，可获得较好的局部区域控制，但远处转移的同时发生限制了生存，必须进一步加以解决。
