Radio(chemo)therapy in the management of squamous cell carcinoma of cervical lymph nodes from an unknown primary site: A retrospective analysis

Purpose: The goal was to retrospectively review the outcome of patients with cervical lymph node metastases of squamuos cell carcinoma of unknown primary site (CUP) treated with radio(chemo)therapy. Patients and methods: A total of 65 patients with CUP N1-3, M0, treated between 1988 and 2009 were evaluated: 61 patients underwent surgical resection followed by postoperative radio(chemo)therapy, 4 patients received definitive radiochemotherapy. Radiotherapy of bilateral neck nodes∈+∈the parapharyngeal region (COMP-RT) was performed in 48 patients (80%) and a unilateral radiotherapy of lymph nodes (UL-RT) in 17 patients (20%). Results: After a median follow-up time of 64 months (range 3-219 months), the estimated 2- and 5-year overall survival (OS) rates were 71∈±∈6% and 48∈±∈7%, respectively. The recurrent free survival (RFS) rate at 2- and 5-years was 58∈±∈6% and 48%∈±∈7%, respectively. Extracapsular spread, resection status (R0 vs. R1/R2), neck lymph node level (I-III vs. IV-V), and Karnofsky index (60-70 vs. 80-100) were significant prognostic factors for OS and RFS in the univariate analysis. Lower nodal stage (N1/N2a vs. N2b/N2c/N3) was significantly associated with a better OS. Resection status and involvement of lymph node level IV significantly affected the OS and RFS in the multivariate analysis. COMP-RT or concurrent chemotherapy was not associated with a better OS or RFS. Conclusion: An advantage of comprehensive radiotherapy or radiochemotherapy compared with unilateral radiotherapy of lymph nodes was not observed.