Treatment of metastatic neck nodes secondary to an occult epidermoid carcinoma of the head and neck

Abstract

One hundred thirty-eight patients, who were followed for a minimum of 5 years, had either surgery and postoperative radiotherapy (48 patients) or radiotherapy only (90 patients) for metastatic epidermoid carcinoma in cervical nodes from an unknown head and neck primary. All received radiotherapy to the presumed occult sites. Forty-five percent presented with a single unilateral adenopathy. Those who were initially operable had a neck recurrence rate of 17% and a survival rate of 53%. Forty-three percent of initially inoperable patients recurred and only 25% survived. Patients with adenopathy which completely regressed or became resectable after irradiation had an 80% locoregional control. Only 4% developed an overt cancer at an occult site within 5 years. Whenever possible, combinations of surgery and radiotherapy should be used in treating these patients. To decrease morbidity, prophylactic irradiation of occult sites should be individualized according to location of cervical nodes and the patient's life-style and socioeconomic conditions.