title: [Standards, Options and Recommendations for the management of patient with carcinoma of unknown primary site].
abstract: BACKGROUND
  The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Cancer Centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
  
  
  OBJECTIVE
  To develop clinical practice guidelines for carcinoma of unknown primary site (CUPS) patients according to the definitions of the Standards, Options and Recommendations project.
  
  
  METHODS
  Data were identified by searching Medline , web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 81 independent reviewers.
  
  
  RESULTS
  The main recommendations for the management of patients CUPS are presented below: 1) An adapted immunochemistry test using a specific antibody battery should be performed for the anatomopathologic diagnosis. 2) The aim of the diagnosis is to identify specific anatomoclinical forms that can be treated by a specific treatment (standard, level of evidence B2). Except these forms, searching for the primary tumor site have no prognosis or therapeutic interest that can justify a systematic diagnosis assessment (standard, level of evidence B2). 3) The management of poorly differentiated neuroendocrine carcinoma consists of platin/etoposide based chemotherapy. There is no standard treatment for the differentiated forms. 4) Surgical node excision and adjuvant radiotherapy should be performed in case of epidermoid carcinoma with cervical node metastases. In the event of a non operable tumor, an irradiation should be performed. 5) The management of axillary node metastases in women with adenocarcinoma should be the same as the management of patients with lymph node metastases in breast cancer. If mammary MRI is negative, surgical treatment and mammary irradiation are not recommended and an axillary node excision should be performed. 6) The standard treatment for women with primary papillary serous carcinoma of the peritoneum is a surgical resection followed by chemotherapy, as recommended for ovarian cancer. 7) CUPS not belonging to any specific anatomoclinical forms can be treated by chemotherapy, symptomatic treatment alone or treatment based on biphosphonates in presence bone metastases.
authors.affiliation: FNCLCC, Standards, Options, Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Bugat
authors.forename: Anne
authors.initials: A
authors.lastname: Bataillard
authors.forename: Thierry
authors.initials: T
authors.lastname: Lesimple
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Voigt
authors.forename: Stéphane
authors.initials: S
authors.lastname: Culine
authors.forename: Alain
authors.initials: A
authors.lastname: Lortholary
authors.forename: Yacine
authors.initials: Y
authors.lastname: Merrouche
authors.forename: Gérard
authors.initials: G
authors.lastname: Ganem
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Kaminsky
authors.forename: Sylvie
authors.initials: S
authors.lastname: Negrier
authors.forename: Maurice
authors.initials: M
authors.lastname: Perol
authors.forename: Céline
authors.initials: C
authors.lastname: Laforêt
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.forename: Gérard
authors.initials: G
authors.lastname: Bertrand
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Coindre
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D001365:Axilla; D018278:Carcinoma, Neuroendocrine / Q000188:drug therapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012737:Sex Factors