CERVICAL LYMPH-NODE METASTASIS FROM AN UNKNOWN PRIMARY - IS A TONSILLECTOMY NECESSARY

Purpose: The detection of an infraclinical primary by tonsillectomy in case of cervical lymph node of an epidermoid carcinoma,vith unknown p rimary after a radical neck dissection, allows avoiding irradiation of the normal larynx. The aim of this study is to quantify the rate of t onsil primary to justify this procedure. Methods and Materials: From 1 969 to 1992, 87 patients had a tonsillectomy as part of the workup for cervical nodal metastasis of an epidermoid carcinoma with unknown pri mary. The mean age was 57 years (range: 39-75 years) and the sex ratio was 8.6. Sixty-seven patients had a single cervical adenopathy (17 N1 , 30 N2a, 5 N3, 15 Nx), and 20 patients multiple cervical adenopathies (17 N2b, 3 N2c). The treatments included always an irradiation to the node areas (50 Gy), and to the pharyngolarynx in case of normal tonsi l (50 Gy), or to the tonsil if it was the primary (50 Gy with a brachy therapy boost of 20-25 Gy). In this last case, the larynx could be pro tected. Results: Tonsillectomy never induced specific complication. Ou t of 87 patients, 26% had a tonsil primary. There was not specific his tological differentiation in this group. In the 67 patients with a sin gle cervical adenopathy, 31% had a tonsil primary (6 N1, 7 N2, 1 N3, 7 Nx). It was a subdigastric adenopathy in 38%, a submandibular in 28% and a midjugulocarotidian in 23%. Among the 17 patients N2b, none had a tonsil primary. In the three patients N2c, two presented a tonsil ca rcinoma (two subdigastric nodes). Conclusion: Tonsillectomy allows avo iding irradiation of normal larynx in 26% of patients who have a cervi cal lymph node with unknown primary. It should be performed in case of a single node of the subdigastric, midjugulocarotidian or submandibul ar area or bilateral subdigastric adenopathies. (C) 1997 Elsevier Scie nce Inc.