title: Metastatic squamous cell carcinoma neck with occult primary: A retrospective analysis.
abstract: BACKGROUND
  Metastatic carcinoma in the lymph nodes of the neck from an unknown primary is relatively rare, accounting for about 3% of all head and neck cancers. Management of secondary neck of undetermined primary is controversial.
  
  
  METHODS
  The case records of all the patients treated in the Department of Radiotherapy, Chatrapati Shahuji Maharaj Medical University, from Oct 1999 to Sep 2004, were studied and the patients with secondary neck without a known primary tumor were analyzed in detail to elucidate the outcome of various treatment modalities in various stages of the disease. One hundred and forty patients were found to be eligible for this analysis. Initial treatment could be divided into two categories: concurrent chemoradiation (n=76) and radiotherapy alone (n=64).
  
  
  RESULTS
  The patients who had received radiotherapy alone (53.1%) had lesser complete response as compared to those who had received chemoradiotherapy (68.4%). The overall survival duration in patients of the radiotherapy treatment group ranged from 5 to 60 months, with an average (±SD) of 31.06 ± 21.01 months, while in the chemoradiotherapy treatment group it ranged from 6 to 60 months, with an average (±SD) of 39.42 ± 21.33 months. Both hematological and nonhematological toxicities, although higher in the chemoradiotherapy group, showed statistically insignificant differences.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the only study evaluating the role of concurrent chemoradiation in cases of secondary neck with primary unknown. The improved response rates along with an increased survival (both disease free and overall) show the superiority of chemoradiotherapy in the management of such cases.
authors.affiliation: Department of Radiation Oncology, TATA Memorial Cancer Hospital, Mumbai, India.
authors.forename: Pragya
authors.initials: P
authors.lastname: Shukla
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
authors.forename: Shyam Singh
authors.initials: SS
authors.lastname: Bisht
authors.forename: Mohan Chand
authors.initials: MC
authors.lastname: Pant
authors.forename: Madan Lal
authors.initials: ML
authors.lastname: Bhatt
authors.forename: Kirti
authors.initials: K
authors.lastname: Srivastava
authors.forename: Mahendra Pal Singh
authors.initials: MP
authors.lastname: Negi