title: Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection.
abstract: OBJECTIVE
  The present study presents the experience at the University of Florida with treatment of patients with squamous cell carcinomas (SCC) metastatic to cervical lymph nodes from an unknown head-and-neck mucosal (H&NM) site with radiotherapy (RT) alone or in combination with neck dissection (ND).
  
  
  METHODS
  The study included 126 patients treated with curative intent from 1964 to 1997. All patients had follow-up for at least 2 years. No patients were lost to follow-up.
  
  
  RESULTS
  Twelve patients (10%) developed SCC in H&NM sites at 0.5 to 10.9 years (median, 1.8 years). The rate of developing carcinomas in H&NM sites at 5 years was 13%. Histologic differentiation significantly affected the rate of developing carcinomas in H&NM sites in multivariate analysis. Sixteen patients (13%) had persistent nodal disease and 12 patients (10%) developed recurrent nodal disease at 0.5 to 10.9 years (median, 1.1 years). The nodal control rate at 5 years was 78%. Nodal size, N stage, and planned ND significantly affected the rate of nodal control in multivariate analysis. Nineteen patients (15%) developed distant metastasis at 0.2-5.1 years (median, 0.9 years). The distant metastases rate at 5 years was 14%. Extracapsular extension and RT dose significantly affected the risk of distant metastases in multivariate analysis. The overall absolute survival rate at 5 years was 47%. Extracapsular extension, N stage, RT dose for H&NM sites, and planned ND significantly affected absolute survival in multivariate analysis. The rate of cause-specific survival at 5 years was 67%. Extracapsular extension, nodal size, N stage, overall treatment time, and planned ND significantly affected cause-specific survival in multivariate analysis. Eight patients (6%) had severe postoperative complications and 6 patients (5%) had severe late complications.
  
  
  CONCLUSIONS
  The present study supports the effectiveness of RT in lowering the rate of developing carcinomas in the H&NM sites.
authors.affiliation: Department of Radiation Oncology, Inönü University Faculty of Medicine, Malatya, Turkey.
authors.forename: H S
authors.initials: HS
authors.lastname: Erkal
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: R J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: D B
authors.initials: DB
authors.lastname: Villaret
authors.forename: S P
authors.initials: SP
authors.lastname: Stringer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / 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; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015996:Survival Rate