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Cervical lymph node metastases from unknown primary cancer: a single-institution experience with intensity-modulated radiotherapy.
Int J Radiat Oncol Biol Phys. 2012 Apr 01; 82(5):1866-71.IJ

Abstract

PURPOSE

To determine the effectiveness and rate of complications of intensity-modulated radiotherapy (IMRT) in the treatment of cervical lymph node metastases from unknown primary cancer.

METHODS AND MATERIALS

Between February 2005 and November 2008, 25 patients with an unknown primary cancer underwent IMRT, with a median radiation dose of 70 Gy. The bilateral neck and ipsilateral putative pharyngeal mucosa were included in the target volume. All patients had squamous cell carcinoma, except for 1 patient who had adenosquamous differentiation. They were all treated with curative intent. Of the 25 included patients, 20 were men and 5 were women, with a median age of 54 years. Of these patients, 3 had Stage III, 18 had Stage IVa, and 4 had Stage IVb. Of the 25 patients, 18 (72%) received platinum-based chemotherapy in a combined-modality setting. Neck dissection was reserved for residual disease after definitive IMRT. Overall survival, disease-free survival, and locoregional control were calculated using the Kaplan-Meier method.

RESULTS

With a median follow-up of 38 months, the overall survival, disease-free survival, and locoregional control rates were all 100% at 3 years. No occurrence of primary cancer was observed during the follow-up period. The reported rates of xerostomia reduced with the interval from the completion of treatment. Nine patients (36%) reported Grade 2 or greater xerostomia at 6 months, and only 2 (8%) of them reported the same grade of salivary function toxicity after 24 months of follow-up.

CONCLUSION

In our institution, IMRT for unknown primary cancer has provided good overall and disease-free survival in all the patients with an acceptable rate of complications. IMRT allowed us to address the bilateral neck and ipsilateral putative pharyngeal mucosa with minimal late salivary function toxicity. The use of concurrent chemotherapy and IMRT for more advanced disease led to good clinical results with reasonable toxicities.

Authors+Show Affiliations

Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada. hugo.villeneuve@umontreal.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21497452

Citation

Villeneuve, Hugo, et al. "Cervical Lymph Node Metastases From Unknown Primary Cancer: a Single-institution Experience With Intensity-modulated Radiotherapy." International Journal of Radiation Oncology, Biology, Physics, vol. 82, no. 5, 2012, pp. 1866-71.
Villeneuve H, Després P, Fortin B, et al. Cervical lymph node metastases from unknown primary cancer: a single-institution experience with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2012;82(5):1866-71.
Villeneuve, H., Després, P., Fortin, B., Filion, E., Donath, D., Soulières, D., Guertin, L., Ayad, T., Christopoulos, A., & Nguyen-Tan, P. F. (2012). Cervical lymph node metastases from unknown primary cancer: a single-institution experience with intensity-modulated radiotherapy. International Journal of Radiation Oncology, Biology, Physics, 82(5), 1866-71. https://doi.org/10.1016/j.ijrobp.2011.02.031
Villeneuve H, et al. Cervical Lymph Node Metastases From Unknown Primary Cancer: a Single-institution Experience With Intensity-modulated Radiotherapy. Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1866-71. PubMed PMID: 21497452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical lymph node metastases from unknown primary cancer: a single-institution experience with intensity-modulated radiotherapy. AU - Villeneuve,Hugo, AU - Després,Philippe, AU - Fortin,Bernard, AU - Filion,Edith, AU - Donath,David, AU - Soulières,Denis, AU - Guertin,Louis, AU - Ayad,Tarek, AU - Christopoulos,Apostolos, AU - Nguyen-Tan,Phuc Felix, Y1 - 2011/04/15/ PY - 2010/04/12/received PY - 2011/02/12/revised PY - 2011/02/14/accepted PY - 2011/4/19/entrez PY - 2011/4/19/pubmed PY - 2012/5/12/medline SP - 1866 EP - 71 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 82 IS - 5 N2 - PURPOSE: To determine the effectiveness and rate of complications of intensity-modulated radiotherapy (IMRT) in the treatment of cervical lymph node metastases from unknown primary cancer. METHODS AND MATERIALS: Between February 2005 and November 2008, 25 patients with an unknown primary cancer underwent IMRT, with a median radiation dose of 70 Gy. The bilateral neck and ipsilateral putative pharyngeal mucosa were included in the target volume. All patients had squamous cell carcinoma, except for 1 patient who had adenosquamous differentiation. They were all treated with curative intent. Of the 25 included patients, 20 were men and 5 were women, with a median age of 54 years. Of these patients, 3 had Stage III, 18 had Stage IVa, and 4 had Stage IVb. Of the 25 patients, 18 (72%) received platinum-based chemotherapy in a combined-modality setting. Neck dissection was reserved for residual disease after definitive IMRT. Overall survival, disease-free survival, and locoregional control were calculated using the Kaplan-Meier method. RESULTS: With a median follow-up of 38 months, the overall survival, disease-free survival, and locoregional control rates were all 100% at 3 years. No occurrence of primary cancer was observed during the follow-up period. The reported rates of xerostomia reduced with the interval from the completion of treatment. Nine patients (36%) reported Grade 2 or greater xerostomia at 6 months, and only 2 (8%) of them reported the same grade of salivary function toxicity after 24 months of follow-up. CONCLUSION: In our institution, IMRT for unknown primary cancer has provided good overall and disease-free survival in all the patients with an acceptable rate of complications. IMRT allowed us to address the bilateral neck and ipsilateral putative pharyngeal mucosa with minimal late salivary function toxicity. The use of concurrent chemotherapy and IMRT for more advanced disease led to good clinical results with reasonable toxicities. SN - 1879-355X UR - https://www.unboundmedicine.com/medline/citation/21497452/Cervical_lymph_node_metastases_from_unknown_primary_cancer:_a_single_institution_experience_with_intensity_modulated_radiotherapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(11)00332-4 DB - PRIME DP - Unbound Medicine ER -