Unknown Primary
Patterns of Spread
- Squamous Cell Carcinoma
- When only neck is treated by surgery the primary recurrence occurs 20% of the time. This number is low due to other deaths and metastatic disease
Site or Origin
Upper Neck node favors
- Nasopharynx
- Oropharynx
- Occasionally melanoma
- Oral cavity
- Larynx
- Hypopharynx
Mid Neck node favors
- Larynx
- Hypopharynx
- Thyroid
- Esophagus
- Disease below the clavical
Lower Neck node favors
- Chest
- Abdomen
- Esophagus
Diagnostic Evaluation
PET
- FDG-PET was the sole procedure that correctly identified occult primary site in 4%. (UF data)
Biopsy Results
- Patients with traditional Radiological exam (-) and PE (-) blind biopsy found the site of primary 17% of the time. (UF data)
- Taking all comer 43% were able to have biopsy proven primary H&N cancers (UF data).
Treatment
Surgery
- N1 disease w/o ECE surgery alone has local control rate of 75% to 85%.
- N1 disease w/o ECE may be treated with a neck dissection alone provided that the neck was not violated with an open procedure prior to surgery.
Radiation Therapy
- Bilateral neck
- Entire oropharynx including the BOT and tonsils
- Entire nasopharynx
- UF does not radiate larynx and hypopharynx
- No oral cavity unless submandibular adenopathy
- UF does not radiate larynx and hypopharynx
- Dose of 64.8 Gy in 1.8 Gy /fraction with AP S/C
- Boost gross adenopathy to 70-75 Gy
Chemotherapy
- Concomitant chemotherapy for advanced N2 and N3 neck
- Cispaltin 30 mg/m2 weekly or Carboplatin and paclitaxel.
Results
- OS-5 is about 48% (MDACC)
- Cause-specific survival at 5 years is 74% (MDACC)
- With surgery alone mucosal primary recurrence rate is 20%
- With RT, mucosal primary occurrence is 10% with 1/3 located in unirradiated sites.
- The incidence of subsequent primary is similar to known rate of secondary primary (ie. RT may completely eliminate primary)
page revision: 1, last edited: 03 Jul 2007 04:59