title: Neck dissection and ipsilateral radiotherapy in the management of cervical metastatic carcinoma from an unknown primary.
abstract: BACKGROUND
  In a small proportion of patients presenting with metastases to cervical lymph nodes the primary cancer remains occult despite thorough evaluation. The present report examines patterns of failure and outcome following an initial treatment strategy directed principally at the clinically involved side of the neck.
  
  
  METHODS
  From a prospectively compiled computerized database 38 patients were identified with metastatic squamous cell carcinoma from an occult primary site. These patients were evaluated with respect to initial treatment, subsequent detection of a primary tumour, neck recurrence and survival characteristics.
  
  
  RESULTS
  Thirty-seven of 38 patients were treated with curative intent and all had neck dissection. Adjuvant radiotherapy was given to 34 of the 37 (90%; 32 postoperatively and two pre-operatively). Radiotherapy was directed at the ipsilateral neck alone in 24 patients while 10 received comprehensive treatment to both sides of the neck and potential occult primary sites. The rate of control of disease in the ipsilateral neck was 91% while the failure rate in the contralateral neck was 16% (six patients). A primary cancer was ultimately identified in five patients (13%). Disease-specific survival was 63% at 4 years. Clinical N3 stage, extracapsular tumour extension and involved surgical margins predicted for poorer survival on univariate analysis. Analysis using multiple risk factors found that only involved surgical margins predicted for treatment failure.
  
  
  CONCLUSIONS
  Despite generally advanced disease at presentation, patients presenting with cervical metastasis from an unknown primary carcinoma have a reasonable survival expectation and aggressive treatment is warranted, but approximately half will develop recurrent disease. Careful follow-up is required if effective salvage treatment is to be instituted.
authors.affiliation: Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: J
authors.initials: J
authors.lastname: McMahon
authors.forename: G
authors.initials: G
authors.lastname: Hruby
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Brien
authors.forename: E B
authors.initials: EB
authors.lastname: McNeil
authors.forename: J S
authors.initials: JS
authors.lastname: Bagia
authors.forename: A R
authors.initials: AR
authors.lastname: Clifford
authors.forename: M A
authors.initials: MA
authors.lastname: Jackson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D009382:Neoplasms, Unknown Primary; D011446:Prospective Studies; D015996:Survival Rate