Metastatic XXXX of the neck from an unknown primary: management options and patterns of relapse.

@entity1 @entity5 @entity957 @entity1442 @entity70677
PURPOSE: Management of @entity957 of undetermined @entity5 in the head and neck region is controversial. Here we report the Southern California Kaiser Permanente experience with these @entity1 . METHODS AND MATERIALS: From January 1969 through December 1994, 106 @entity1 were eligible for this retrospective analysis. Distribution of nodal staging was as follows: 14 N1, 27 N2A, 39 N2B, 2 @entity70677 , and 24 N3. Initial treatment included excisional biopsy alone in 12, radical neck dissection alone in 29, radiotherapy alone in 24, excisional biopsy followed by radiotherapy in 15, and radical neck dissection plus postoperative radiation in 26 @entity1 . RESULTS: Except for two @entity1 , all @entity1 have had a minimum follow-up of 5 years. Overall, 57 @entity1 (54%) have had recurrences. Only two @entity1 (3%) who had received radiotherapy as part of their initial treatment had an appearance of a potential primary site inside the irradiated field vs 13 @entity1 (32%) who had not received radiotherapy (p =.006). Combined modality therapy resulted in fewer neck relapses, particularly in @entity1 with @entity1442 . Including salvage, surgery alone as the initial treatment resulted in 81% ultimate @entity5 control above the clavicle for @entity1 with N1 and N2a disease without extracapsular extension. The 5-year survival for the entire population was 53%. Radiotherapy alone resulted in poor survival in @entity1 with advanced/unresectable neck disease. No significant difference in survival based on the initial treatment was found. The statistically significant adverse factors in determining survival included advanced nodal stage and the presence of extracapsular extension. CONCLUSIONS: Radiotherapy is very effective in reducing the rate of appearance of a potential primary site. However, in the absence of @entity1442 (N1 and N2A without extracapsular extension), radiotherapy can be reserved for salvage. Radiotherapy alone results in poor outcomes in @entity1 with advanced/unresectable neck disease, and incorporation of concurrent chemotherapy and cytoprotective agents should be investigated.
