CERVICAL METASTASES OF OCCULT ORIGIN - THE IMPACT OF COMBINED-MODALITY THERAPY

BACKGROUND: We have updated our experience with metastatic carcinoma t o the neck of occult origin to assess whether increasing use of adjunc tive radiation therapy has had a significant impact. METHODS: This ret rospective review of 115 patients treated between 1977 and 1990 includ es 73 (63%) with squamous cell carcinoma. These 73 patients were analy zed for survival, control of disease in the neck, and incidence of sub sequent primary turners. RESULTS: There has been no change in the prop ortion of patients with advanced neck disease (N2/N3 = 52; 71%) when c ompared to our last report. Surgery included comprehensive neck dissec tion in 59 (81%) and adjunctive radiotherapy was employed in 54 (81% o f surgically treated patients). Primary carcinomas within the head and neck were identified subsequently in 9 (12%) patients, including 4 of 11 (36%) who did not have adjunctive radiotherapy and 5 of 54 (9%) wh o did (P = 0.038). Control of the treated neck (54/73; 74%) has improv ed significantly (P = 0.005) when compared to our earlier experience ( 37/74; 50%), and this was most apparent in those with extensive neck d isease. However; cumulative survival at 5 years (45%) was not signific antly different from that previously reported. CONCLUSION: Our data su pport the increased use of adjunctive radiation therapy for metastatic squamous cell carcinoma in the neck of occult origin. Control of neck disease has improved and the likelihood that a primary will be identi fied has been reduced, but there has been no improvement in survival w hen compared to historical controls.