gms | German Medical Science

The aim of this retrospective analysis is to assess the outcome in patients with neck metastases from an unknown primary tumor. Furthermore, prognostic factors and treatment modalities are discussed.

Patients and methods: From 2000 to 2011, 17 patients with neck metastases from unknown primary tumor were treated at the University ORL Clinic Nis, Serbia.

Clinical evaluation of patients includes a complete medical history and physical examination, chest radiograph, and indirect or flexible fiberoptic endoscopy. Computed tomography was used to evaluate the chest and neck. Laryngoscopy, bronchoscopy, esophagoscopy, nasopharyngoscopy, and biopsy of all suspicious lesions were performed to evaluate pulmonary and upper aerodigestive tract sites.

Results: Primary tumor location was identified in 11 patients. Subsequent directed bilateral biopsies of the most likely occult primary tumor sites (tongue base, nasopharynx, tonsils, and piriform sinus) yielded positive results in 11 cases. In 17 patients, neck dissection (13 radical, 3 modified radical) was performed. All 17 patients received extended radiotherapy including both sides of the neck and potential mucosal primary sites.

Conclusions: Metastatic cervical adenopathy of unknown primary origin poses a diagnostic challenge of considerable clinical consequence in patients with head and neck cancer. Patients with neck node metastases from occult head and neck cancer have clinical features and prognosis similar to other head and neck malignancies. Extensive irradiation to both sides of the neck and the mucosa in the entire pharyngeal axis and larynx resulte in significantly less loco-regional failures.

Supported by: This work was supported by a grant No 175092 from the Ministry of Science and Technological Development of Serbia.

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