Neck lymph node metastasis from unknown primary lesion

Halay O.O.1, Bilynskyi B.T.2, Bondarenko S.G.1, Duda O.R. 1, Druzuk O.V.1, Karp S.U.1, Ludchak V.Y.1, Sendega I.M.1, Slipetsky R.R.2, Shmidt M.R.1, Colko T.R.1

Summary. Aim. To study the results of treatment of patients with metastases in the lymph nodes of the neck without a primary focus. Materials and methods. A retrospective analysis of data on 86 patients who were treated in the Lviv Cancer Center was performed. 8 groups were allocated depending on the method of treatment. Surgical treatment was performed in 13 (15.1%) patients, 12 (14.0%) patients underwent surgery + adjuvant radiation therapy, 15 (17.4%) underwent chemoradiotherapy after surgery, and 6 (7.0%) cases — postoperative chemotherapy. A course of radiation therapy was carried out in 8 (9.3%) patients, in only 4 (4.7%) cases chemotherapy, and 25 (29.0%) patients refused treatment. Histologically, the distribution was as follows: squamous cell carcinoma — 67.4% (n=58), adenocarcinoma — 17.4% (n=15), melanoma — 7.0% (n=6), undifferentiated cancer and neuroendocrine tumor — 3 each (3.5%) cases. Results. The average life expectancy in patients with metastases to the lymph nodes of the neck without a primary focus was 21.34±3.33, and the median was 7.0 months. Combined treatment was effective: an operation followed by a course of chemoradiotherapy — the median survival was 27 months, and the average life expectancy was 40.0±10.0 months. The lowest survival rates were obtained with monotherapy: the median survival after radiation therapy was 8.0 months, after chemotherapy — 7.0 months. It is logical that the average life expectancy in patients who refused treatment was 4.33±0.9 months, and the median was only 3.0 months. Pearson’s method obtained a statistically significant difference between the groups, p=0.0003. Also, low survival rates were found in patients with melanoma metastases, where the average life expectancy was only 3.3±0.7 months. If, after conducting basic diagnostic examinations, the primary lesion is not verified, it is impractical to spend time searching for it. According to the data obtained, overall survival depends little on identifying the source of metastasis, so treatment should be started, the schemes and methods of which have long been identified. Of course, this does not mean abandonment of detailed monitoring of the condition of patients in order to identify the primary focus in dynamics.

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