title: Role of radiotherapy in the treatment of cervical lymph node metastases from an unknown primary site: retrospective analysis of 113 patients.
abstract: OBJECTIVE
  The management of patients with cervical lymph-node metastases from unknown primary site (UPS) remains a matter of discussion. This study aimed to analyze the results and prognostic factors in a series of patients treated with radiotherapy.
  
  
  METHODS
  Data from 113 patients who presented with cervical lymph nodes metastases from UPS treated from 1980 to 2004 were reviewed. Eighty-seven patients (77.0%) were squamous cell carcinoma (SCC). Ninety-one patients were treated with curative and 22 with palliative intent. Fifty-nine of 113 patients (52.2%) received surgery followed by radiotherapy and 54 of 113 (47.8%) received radiotherapy alone. Radiotherapy was delivered to the neck and pharyngeal mucosa in 67 patients and to the ipsilateral or bilateral neck in 45 patients. Twenty-one patients (18.5%) also received chemotherapy.
  
  
  RESULTS
  The 5-year overall survival rates were 40.7% for the entire group and 46.6% for the SCC subgroup. The occurrence of the occult primary was observed in 23 of 113 patients (20.3%), 19 (82.6%) within the head and neck region. At multivariate analysis, treatment with curative intent and extensive irradiation of bilateral neck and pharyngeal mucosa were favorable prognostic factors for the whole series, and treatment with curative intent, extensive irradiation of bilateral neck and pharyngeal mucosa, and absence of extracapsular spread were favorable prognostic factors for the SCC subgroup.
  
  
  CONCLUSIONS
  Patients with cervical lymph node metastases from UPS have a similar prognosis to those affected by other head and neck malignancies. Curative treatment strategies including neck dissection and extensive irradiation by three-dimensional conformal radiation therapy resulted in significantly better outcomes.
authors: Radiotherapy Department, Hospital Maggiore della Carità, Novara, Italy.
authors: Debora
authors: D
authors: Beldì
authors: Barbara A
authors: BA
authors: Jereczek-Fossa
authors: Alberto
authors: A
authors: D'Onofrio
authors: Giuseppina
authors: G
authors: Gambaro
authors: Maria Rosaria
authors: MR
authors: Fiore
authors: Francesco
authors: F
authors: Pia
authors: Fausto
authors: F
authors: Chiesa
authors: Roberto
authors: R
authors: Orecchia
authors: Marco
authors: M
authors: Krengli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D009333:Neck; D037981:Neck Dissection; D009382:Neoplasms, Unknown Primary; D011379:Prognosis; D012044:Regression Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate