title: Selective neck dissection as a therapeutic option in management of squamous cell carcinoma of unknown primary.
abstract: Carcinoma of unknown primary of the neck (CUP) is a metastasis presenting in one or more cervical lymph nodes, with no primary mucosal site identified. Retrospective case notes review of 25 consecutive patients (median age 55, 72% males) diagnosed as CUP who underwent neck dissection in a UK tertiary referral comprehensive cancer centre between 2000 and 2011. Median follow-up was 33 months. Nineteen patients underwent comprehensive neck dissections (six extended), six patients had selective neck dissection. Five year disease specific survival and regional recurrence free survival were 76 and 80% respectively. The overall rate of occult disease (disease not identified on preoperative evaluation, but found on histopathologic examination) was 8%, with rates of 0% in level I and 6% in level V. Our study suggests that in patients without preoperative evidence of disease in levels I or V selective neck dissection might be considered as an option, to facilitate preservation of the submandibular gland and accessory nerve without compromising oncological outcome. Larger studies should be performed before a change in practice can be advised.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Alina Denisa
authors.initials: AD
authors.lastname: Dragan
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Guerrero-Urbano
authors.forename: Richard
authors.initials: R
authors.lastname: Oakley
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jeannon
authors.forename: Ricard
authors.initials: R
authors.lastname: Simo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy*; D049268:Positron-Emission Tomography; D018714:Radiotherapy, Adjuvant; D014057:Tomography, X-Ray Computed
references.citation: Arch Otolaryngol Head Neck Surg. 2009 Oct;135(10):1024-9
references.pmid: 19841343
references.citation: Laryngoscope. 2009 Dec;119(12):2348-54
references.pmid: 19718744
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):1158-66
references.pmid: 18258383
references.citation: Am J Otolaryngol. 2011 Jul-Aug;32(4):286-90
references.pmid: 20719404
references.citation: Arch Otolaryngol Head Neck Surg. 2005 Jul;131(7):626-9
references.pmid: 16027287
references.citation: Head Neck. 2011 Nov;33(11):1569-75
references.pmid: 21990221
references.citation: Int J Radiat Oncol Biol Phys. 2010 Nov 15;78(4):1005-10
references.pmid: 20207504
references.citation: World J Surg Oncol. 2005 Apr 18;3(1):21
references.pmid: 15836786
references.citation: Int J Radiat Oncol Biol Phys. 2011 Oct 1;81(2):346-52
references.pmid: 20933340
references.citation: Arch Otolaryngol Head Neck Surg. 2006 Jun;132(6):662-6
references.pmid: 16785413
references.citation: Head Neck. 2011 Jul;33(7):1060-7
references.pmid: 20960564
references.citation: Tumori. 2009 Mar-Apr;95(2):185-90
references.pmid: 19579864
references.citation: J Clin Oncol. 2006 Jun 10;24(17):2629-35
references.pmid: 16763276
references.citation: Head Neck. 2008 Jan;30(1):28-34
references.pmid: 17657782
references.citation: Laryngoscope. 2011 Jun;121(6):1194-201
references.pmid: 21495044
references.citation: Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):1100-7
references.pmid: 17980501
references.citation: Head Neck. 1997 Jan;19(1):48-53
references.pmid: 9030945
references.citation: Am J Surg. 1990 Oct;160(4):405-9
references.pmid: 2221244
references.citation: Head Neck. 2003 Nov;25(11):960-7
references.pmid: 14603457
references.citation: Head Neck. 2007 Jun;29(6):585-90
references.pmid: 17274051
references.citation: Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):291-6
references.pmid: 9308930