METASTATIC SQUAMOUS-CELL CARCINOMA TO CERVICAL LYMPH-NODES FROM UNKNOWN PRIMARY MUCOSAL SITES

Between 1978 and 1991, 54 patients with metastatic squamous cell or un differentiated carcinoma to the cervical lymph nodes, with unknown pri mary mucosal sites, were treated with curative intent at McGill Univer sity teaching hospitals. The median age at diagnosis was 58 years with a male:female ratio of 6:1. All patients presented with a painless ne ck mass. Five patients (9%) presented with N1 disease, 28 (52%) with N 2a disease, four (7%) with N2b disease, three (6%) with N2c disease, a nd 14(26%) with N3 disease. Twenty-four patients (44%) underwent neck dissection, and 30 (56%) had only excisional lymph node biopsy. Fifty- three patients (98%) were treated with radiotherapy to a median dose o f 60 Gy (range 38 to 66 Gy) in 30 fractions. With a median follow-up t ime of 49 months, the overall actuarial survival was 63% and 59% at 5 and 10 years, respectively. Three patients were found to have a subseq uent primary head and neck tumor. The single most important prognostic factor was the N stage, which influences both neck control and long-t erm survival. There was no statistically significance difference in su rvival or local neck control rates between patients who had neck disse ction or excisional lymph node biopsy (p > 0.05). (C) 1994 John Wiley & Sons, Inc.