Institute of Radiation Oncology of the 1st Faculty of Medicine Charles University, Bulovka University Hospital, Budínova 2, 18001 Praha 8, Prague, Czech Republic.
Radiophysics Department, Bulovka University Hospital, Prague, Czech Republic.
Strahlenther Onkol. 2023 Feb;199(2):149-159. doi: 10.1007/s00066-022-01983-6. Epub 2022 Aug 9.
To evaluate the effectiveness and toxicity of curative (chemo)radiotherapy in patients with metastatic carcinoma to cervical lymph nodes from an unknown primary.
Retrospective study of 90 consecutive patients, treated with curative radiotherapy from 2003 to 2018 (median age 59 years; current/former smokers 76%) was conducted. The distribution of nodal staging was as follows: N1: 12%, N2a: 21%, N2b: 43%, N2c: 10%, N3: 13%. In 62% of patients, neck dissection was performed before radiotherapy. Concomitant chemotherapy was given to 64% of patients.
The median follow-up of surviving patients was 86 months. The median total radiotherapy dose achieved was 70 Gy. The 5‑ and 10-year locoregional control were 84% in both cases, while 5‑ and 10-year distant control were 90% and 89%, respectively. A primary tumor in the head and neck area was detected in only 2 patients. No patient had an initial failure in the pharyngeal axis or contralateral cervical nodes. The 5‑ and 10-year overall survival were 55% and 42%, respectively. Severe early toxicity occurred in 71%; severe late toxicity in 33% of patients. Multivariate analysis demonstrated N‑status (hazard ratio [HR] 2.424; 95% confidence interval [CI] 1.121-5.241; p = 0.024) and comorbidity scores assessed by ACE-27 (Adult Comorbidity Evaluation; HR 3.058; 95% CI 1.489-6.281; p = 0.002) as two independent prognostic factors for overall survival.
The results of our work study demonstrate the high effectiveness of curative (chemo)radiotherapy on the pharyngeal axis and bilateral cervical nodes with long-term locoregional and distant control in 3/4 of the treated patients. N‑status and comorbidity scores were shown as strong prognostic factors influencing overall survival.
评估治疗性（化疗）放疗对不明原发灶颈淋巴结转移癌患者的疗效和毒性。
回顾性分析了 90 例连续患者的资料，这些患者于 2003 年至 2018 年期间接受了根治性放疗（中位年龄 59 岁；当前/曾经吸烟者占 76%）。淋巴结分期分布如下：N1：12%，N2a：21%，N2b：43%，N2c：10%，N3：13%。在 62%的患者中，在放疗前进行了颈部清扫术。64%的患者接受了同期化疗。
存活患者的中位随访时间为 86 个月。中位总放疗剂量为 70Gy。5 年和 10 年局部区域控制率分别为 84%。5 年和 10 年远处控制率分别为 90%和 89%。仅在 2 例患者中发现头颈部有原发肿瘤。没有患者在咽轴或对侧颈淋巴结出现初始失败。5 年和 10 年总生存率分别为 55%和 42%。71%的患者出现严重早期毒性，33%的患者出现严重晚期毒性。多因素分析显示 N 分期（风险比 [HR] 2.424；95%置信区间 [CI] 1.121-5.241；p=0.024）和 ACE-27（成人合并症评估）评估的合并症评分（HR 3.058；95%CI 1.489-6.281；p=0.002）是影响总生存率的两个独立预后因素。
我们的研究结果表明，在 3/4 的治疗患者中，治疗性（化疗）放疗对咽轴和双侧颈淋巴结具有较高的疗效，可实现长期局部区域和远处控制。N 分期和合并症评分是影响总生存率的强有力预后因素。
