title: [Lymph node metastases from squamous cell carcinoma of unknown primary site. Is it time to change of paradigm?].
abstract: The diagnosis of carcinoma of unknown primary (CUP) is made after exclusion of the presence of a mucosal primary. There are two mains options for the primary treatment of CUP, either a neck node dissection followed by postoperative radiotherapy or chemo-radiotherapy, or a primary radiotherapy or chemo-radiotherapy depending on the nodal stage followed in case of residual neck disease by a selective neck dissection. There is no data to suggest the superiority of one over the other. For radiotherapy, unilateral neck or bilateral neck, including the upper aerodigestive tract mucosa are possible options. There is no definite data to demonstrate the superiority of one over the other, but owing the reduced toxicity of unilateral irradiation, and the possibility of salvage treatment in case of emergence of a mucosal primary and/or a contralateral neck node development, the former may be the preferred option. Advances in radiotherapy such as intensity modulated radiation therapy have the potential to spare organs at risk and reduce late toxicity rates. A selective irradiation approach customized on "major" criteria, such as nodal stage and level, HPV and EBV status and accessory criteria, such as histological variants, is under investigation.
authors.affiliation: Institut de recherche expérimentale et clinique, Université catholique de Louvain, Centre du cancer des cliniques universitaires St-Luc, Unité de chirurgie cervico-faciale, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.affiliation: Pôle régional cancérologie, Centre hospitalier régional universitaire, Service de radiothérapie oncologique, Poitiers, France.
authors.forename: Idriss
authors.initials: I
authors.lastname: Troussier
authors.affiliation: Institut de recherche expérimentale et clinique, Université catholique de Louvain, Centre du cancer des cliniques universitaires St-Luc, Service d'oncologie médicale, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Machiels
authors.affiliation: Institut de recherche clinique expérimentale, Université catholique de Louvain, Centre du cancer des cliniques universitaires St-Luc, Service de stomatologie et chirurgie maxillo-faciale, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
authors.forename: Hervé
authors.initials: H
authors.lastname: Reychler
authors.affiliation: Institut de recherche expérimentale et clinique, Université catholique de Louvain, Centre du cancer des cliniques universitaires St-Luc, Unité de chirurgie cervico-faciale, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
authors.forename: Sandra
authors.initials: S
authors.lastname: Schmitz
authors.affiliation: Institut universitaire de la face et du cou, Université Nice-Sophia Antipolis, Centre Antoine-Lacassagne, Service de radiothérapie oncologique, Nice, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Institut de recherche expérimentale et clinique, Université catholique de Louvain, Centre du cancer des cliniques universitaires St-Luc, Service de radiothérapie oncologique, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
authors.forename: Vincent
authors.initials: V
authors.lastname: Grégoire
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D009333:Neck; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods
keywords: cervical lymph node metastases; chemoradiotherapy; neck dissection; squamous cell carcinoma; unknown primary