title: [Significance of Secondary Mucosal Primaries in Patients with a Cervical CUP-Syndrome].
abstract: BACKGROUND
  We discuss the significance of an occult primary in the prognosis of cervical carcinoma with unknown primary (CUP) after completion of diagnostic and treatment.
  
  
  METHODS
  A series of 36 patients diagnosed between 2001 and 2009 underwent staging including panendoscopy, mapping and tonsillectomy, ultrasound and CT/MRI of the neck, thorax and abdomen. The patients recieved neck surgery followed by adjuvant radio-(chemo-)therapy of cervical fields as well as limited mucosal irradiation (IMRT, GHD 50 Gy). The results of tumor control and therapy-related toxicity were ascertained.
  
  
  RESULTS
  A secondary primary of the cervical metastases was not detected during follow-up. 6 patients died from distant metastases and 1 from chemotherapy; 4 patients died from a different secondary tumour, 2 patients died intercurrently. We did not observe late toxicity but 8% of patients had Grade 3 dysphagia.
  
  
  CONCLUSIONS
  Efficacy of diagnostic procedure and therapy are important in treating occult primary tumours in CUP. Our results show that omitting PET-CT, which was not available in diagnostic workup of the study-patients, did not impact negatively on the manifestation rate of mucosal primaries and/or was compensated for by intensive therapy. Distant metastases and infraclavicular secondary primaries had a negative impact for the survival. Elective therapy of a presumed occult primary tumour in CUP should be included into the therapeutic discussion considering its efficacy and toxicity.
authors.affiliation: HNO - Plastische Operationen, Medizinische Hochschule Brandenburg, Campus, Neuruppin.
authors.forename: A M
authors.initials: AM
authors.lastname: Franzen
authors.affiliation: HNO - Plastische Operationen, Medizinische Hochschule Brandenburg, Campus, Neuruppin.
authors.forename: A
authors.initials: A
authors.lastname: Lieder
authors.affiliation: Klinik für Strahlentherapie und, Medizinische Hochschule Brandenburg, Campus, Neuruppin.
authors.forename: A
authors.initials: A
authors.lastname: Buchali
mesh_terms: D006258:Head and Neck Neoplasms; D006801:Humans; D008207:Lymphatic Metastasis; D009333:Neck; D037981:Neck Dissection; D009382:Neoplasms, Unknown Primary; D000072078:Positron Emission Tomography Computed Tomography