Kirschner M J, Fietkau R, Waldfahrer F, Iro H, Sauer R
Klinik für Strahlentherapie, Universität Erlangen-Nürnberg.
Strahlenther Onkol. 1997 Jul;173(7):362-8. doi: 10.1007/BF03038239.
The primary tumor remains unknown in approximately 3 to 9% of patients with lymph node metastases in the neck. Management of these patients is still controversial particularly because of the commonly as poor assessed prognosis. The treatment outcome was surveyed by a retrospective analysis, trying to identify prognostic factors.
From 1979 through 1993, 64 patients with metastatic carcinoma of unknown primary tumor involving neck lymph nodes were treated. Most of them (n = 40) were squamous cell carcinomas. Forty-eight patients underwent surgical resection of the involved nodes by neck dissection or excisional biopsy. Surgery was performed in 41 patients before and in 7 patients after radiotherapy. Additional chemotherapy was administered to 12 patients (simultaneously to 11 patients). The irradiated volume included both sides of the neck, the supraclavicular region and the whole pharynx. The mean radiation dose was 59 Gy. In 32 patients, an additional boost to epipharynx (n = 23) and/or large lymph nodes (n = 11) was given (mean: 12 Gy) by external beam therapy, in 2 cases by interstitial implants (22 Gy). Mean follow-up time was 8 years (range: 7 months to 15 years, median: 9 years).
Fifty-two out of 64 (81.2%) patients came into a complete remission and 12 into a partial remission. The cause specific survival after 5 years for the whole group was 51.0 +/- 7%, the overall survival 38.8 +/- 7%. Within the irradiated area the tumor control was 68.3 +/- 7%, the distant metastatic-free survival 70.0 +/- 7%. Best results showed patients after surgery+radiation (n = 48) with 67% overall survival at 5 years versus 0% (median: 9.2 months) without surgery (n = 16), and patients with lymph nodes located above the glottic level (n = 49) 63.2% versus 9.0% (median: 1.2 years, n = 12). The primary tumor appeared in 9 patients (4 times above the clavicles), once in the irradiated volume.
Patients with cervical metastases of unknown primaries do not fare worse than patients with advanced carcinoma of head and neck and should be treated with a curative intent preferably by surgery and radiotherapy.
在颈部淋巴结转移患者中，约3%至9%的患者原发肿瘤仍不明。这些患者的治疗仍存在争议，尤其是因为其预后通常评估较差。通过回顾性分析对治疗结果进行了调查，试图确定预后因素。
1979年至1993年，对64例颈部淋巴结有不明原发肿瘤转移癌的患者进行了治疗。其中大多数（n = 40）为鳞状细胞癌。48例患者通过颈部清扫术或切除活检对受累淋巴结进行了手术切除。41例患者在放疗前进行了手术，7例患者在放疗后进行了手术。12例患者接受了额外的化疗（11例同时进行）。照射范围包括双侧颈部、锁骨上区域和整个咽部。平均放射剂量为59 Gy。32例患者通过外照射对咽上区（n = 23）和/或大淋巴结（n = 11）进行了额外的加量照射（平均：12 Gy），2例通过组织间植入（22 Gy）。平均随访时间为8年（范围：7个月至15年，中位数：9年）。
64例患者中有52例（81.2%）完全缓解，12例部分缓解。整个组5年后的病因特异性生存率为51.0 +/- 7%，总生存率为38.8 +/- 7%。在照射区域内，肿瘤控制率为68.3 +/- 7%，无远处转移生存率为70.0 +/- 7%。手术+放疗后的患者（n = 48）5年总生存率为67%，而未手术的患者（n = 16）为0%（中位数：9.2个月），声门上水平以上有淋巴结的患者（n = 49）为63.2%，而声门上水平以下有淋巴结的患者（n = 12）为9.0%（中位数：1.2年），结果最佳。9例患者出现了原发肿瘤（4例在锁骨上方），1例在照射范围内。
不明原发灶的颈部转移患者的预后并不比晚期头颈癌患者差，应采取根治性治疗，最好采用手术和放疗。
