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Tumor control of cervical lymph node metastases of unknown primary origin: the impact of the radiotherapy target volume

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Debate on the extent of treatment of neck metastasis of cancer of unknown primary tumors (CUPs) is still ongoing. In two Dutch tertiary referral centers, the post-surgical radiation target volume changed from the bilateral neck including the pharyngeal axis to the unilateral neck only, in the course of the last decade. This study aims to investigate the outcome of patients with CUP before and after de-escalation of post-surgical radiotherapy.

Methods

Data of two Dutch tertiary referral centers were merged. Disease-free survival (DFS), overall survival (OS), and regional control rate (RCR) of 80 patients diagnosed with CUP (squamous cell and undifferentiated carcinomas) between 1990 and 2009 were retrospectively analyzed.

Results

Thirty patients received bilateral neck and pharyngeal axis radiotherapy and 42 patients ipsilateral radiotherapy only. In another eight patients, the postsurgical radiation target volume was expanded to the contralateral neck or to the pharyngeal axis, due to suspicious lesions on imaging. The 5-year DFS, OS and RCR were 60%, 51.2%, and 80%, respectively, in the total patient population. RCR did not differ in patients treated with ipsilateral as compared to bilateral radiotherapy nor did 5-year OS and DFS. No tumors occurred in the pharyngeal axis.

Conclusion

In this study, omitting elective treatment of the contralateral neck and pharyngeal axis did not lead to a decrease in locoregional control or survival rates when treating patients with CUP.

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Funding

No funding was received for this study.

Author information

Author notes

  1. Jos M. J. A. A. Straetmans

    Present address: Department of Otorhinolaryngology and Head and Neck Surgery, Zuyderland Medical Center, H. Dunantstraat 5, 6419 PC, Heerlen, The Netherlands

Authors and Affiliations

  1. Department of Otorhinolaryngology and Head and Neck Surgery, Research Institute GROW, Maastricht University Medical Center, P.O. BOX 5800, 6202 AZ, Maastricht, The Netherlands

    Jos M. J. A. A. Straetmans, Marijn Stuut, Sanne Wagemakers, Bernd Kremer & Martin Lacko

  2. Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands

    Frank Hoebers

  3. Department of Radiation Oncology, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 22, 6525 GA, Nijmegen, The Netherlands

    Johannes H. A. M. Kaanders

  4. Department of Pathology, Research Institute GROW, Maastricht University Medical Center, Maastricht, The Netherlands

    Ernst Jan M. Speel

  5. Department of Medical Microbiology, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 22, 6525 GA, Nijmegen, The Netherlands

    Willem J. G. Melchers

  6. Department of Pathology, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 22, 6525 GA, Nijmegen, The Netherlands

    Piet Slootweg

  7. Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 22, 6525 GA, Nijmegen, The Netherlands

    Robert P. Takes

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  1. Jos M. J. A. A. Straetmans
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  2. Marijn Stuut
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  7. Willem J. G. Melchers
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  8. Piet Slootweg
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Corresponding author

Correspondence to Jos M. J. A. A. Straetmans.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Medisch Ethische Commissie Maastricht University Medical Center and Radboud University Medical Center Nijmegen, The Netherlands) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Straetmans, J.M.J.A.A., Stuut, M., Wagemakers, S. et al. Tumor control of cervical lymph node metastases of unknown primary origin: the impact of the radiotherapy target volume. Eur Arch Otorhinolaryngol 277, 1753–1761 (2020). https://doi.org/10.1007/s00405-020-05867-2

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  • DOI: https://doi.org/10.1007/s00405-020-05867-2

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