CARCINOMAS OF UNKNOWN PRIMARY SITE - A STUDY BASED ON 100 PATIENTS TREATED AT THE MONTPELLIER-CANCER-CENTER

Purpose. - Carcinomas of unknown primary site are frequent neoplasms w hich raise diagnostic and therapeutic problems in clinical practice. M ethods. - Clinical records of 100 patients with carcinoma of unknown p rimary site whose clinical management took place at the Centre Regiona l de Lutte Contre le Cancer de Montpellier were retrospectively review ed. Initial clinical and biological characteristics, pre-treatment eva luation, therapies and outcome were recorded. Results. - Three main hi stological types were observed: adenocarcinoma (66 patients), poorly d ifferentiated carcinoma (19 patients), epidermoid carcinoma (11 patien ts). Bone, lung, lymph nodes and liver were the most frequently involv ed metastatic sires. Analysis of the investigations aimed at identifyi ng the primary site (none of which being positive) showed 68 different combinations in 100 patients. Anemia (< 100 g/L) was observed in 10 p atients, while serum alkaline phosphatase was increased in 42 patients . Seven patients died before any therapy. Chemotherapy or radiotherapy was advocated in 70 and 59 patients, respectively Thirty-sir patients had concomitant chemoradiotherapy. Chemotherapy included a platinum d erivative in 53 patients. The median number of cycles was four. Nine o bjective responses were observed, six of which occurred in patients wh o were receiving platinum-based chemotherapy. Ninety-six deaths were e ncountered, 95 due to the disease progress and one due to an intercurr ent cause. The median survival was 9 months. Univariate analysis ident ified two prognostic factors: the number of metastatic sires and the s erum alkaline phosphatase.Conclusions. - This retrospective study conf irms the difficulties in the management of patients with carcinomas of unknown primary site. A literature review suggests limited diagnostic investigations in clinical practice with the aim of identifying tumor s of potential prognostic (breast and ovary) or therapeutic (prostate) value. Apart from specific subgroups of patients for whom specific th erapy is recommended, there is no current standard chemotherapy. (C) 1 998 Elsevier, Paris.