UNKNOWN PRIMARY OF THE HEAD AND NECK

The occurrence of metastases to the cervical lymph nodes from an unkno wn primary tumour is seen in approximately three to six per cent of pa tients with cervical adenopathy and the primary tumour commonly remain s elusive. Single modality treatment is occasionally advocated but com bined treatment seems to obtain the best results. A retrospective anal ysis of patients' charts with unknown primary of the head and neck in the University of Michigan Medical Center was undertaken for the years 1978-1992. Forty-eight records met study criteria and were reviewed. Our series' size and heterogeneity prevents drawing conclusions regard ing treatment effectiveness. The majority (67.5 per cent) of our patie nts were treated by surgery followed by irradiation. Our overall survi val rates compare favourably with the general statistics although it s hould be noted that longer follow-up in our first group of patients ma y alter our results. Extracapsular spread did not adversely affect sur vival in our small series of five cases. We discovered six primary sit es within one year and three additional cases within four years. The p rimary site was included in the radiation fields in all instances of s quamous cell tumours that were eventually found. It has been suggested that eventual manifestation of the primary site adversely affects pro gnosis, which is in agreement with our results.