Induction Chemotherapy Followed by Radiotherapy in Patients with Cervical Lymph Node Metastases from Unknown Primary Carcinoma

被引：2
作者：
Seol Y.M. [1 ]
Choi Y.J. [1 ]
Lee B.J. [2 ]
Wang S.G. [2 ]
机构：
[1] Division of Hematology/Oncology, Department of Internal Medicine, Pusan National University Hospital, Medical Research Institute, Busan
[2] Department of Otolaryngology, Pusan National University Hospital, Medical Research Institute, Busan
来源：
Indian Journal of Otolaryngology and Head & Neck Surgery | 2015年 / 67卷 / Suppl 1期
关键词：
Head and neck cancer; Induction chemotherapy; Lymph node metastasis; Unknown primary;
D O I：
10.1007/s12070-014-0773-8
中图分类号：
学科分类号：
摘要：
Cervical metastases from unknown primary tumors are rare and no clear therapeutic options are available. This study was performed to assess the efficacy and safety profiles of induction chemotherapy followed radiotherapy in patients with cervical lymph node metastases from unknown primary cancer. Patients with histological diagnosis of cervical lymph-node metastasis from carcinoma with an unknown primary cancer underwent induction chemotherapy followed by radiotherapy. All patients had squamous cell carcinoma. Induction chemotherapy consisted of 3–4 cycles every 3 weeks of docetaxel (day 1.70 mg/m2) and cisplatin (day 1.75 mg/m2). Radiation therapy (RT) was started with in 10 weeks of the last cycle of chemotherapy, and it was administered 5 days per week. It was given in daily fractions of (1.8) Grays (Gy) of 2 Gy and the total dose to the primary tumor was 70–74 Gy. Neck dissection was reserved for residual disease after definitive radiotherapy. Overall survival, recurrent free survival, and locoregional control were calculated using the Kaplan–Meier method. Twenty one patients with an unknown primary cancer underwent induction chemotherapy and radiotherapy. After induction chemotherapy, 6 patients achieved CR and 8 patients achieved PR. The overall response rate after radiation, was 90.4 % (19 of 21 patients). Neutropenia and infection were the most common grade 3–4 adverse event during induction chemotherapy. Mucositis and dermatitis were the most common grade 3–4 toxicities during radiotherapy. With a median follow-up of 50.6 months, the estimated 2 years OS rates were 71 ± 6 %, respectively. The median OS was 42 months (95 % confidence interval CI 8–65 months). The recurrent-free survival rate at 2 years was 57 %, respectively. In the patients with responder to induction chemotherapy, superior relapse free survival and overall survival rate observed. No occurrence of primary cancer was observed during the follow-up period. Induction chemotherapy followed RT for unknown primarycancer has provided good overall and disease-free survival in all the patients with anacceptable rate of complications. The use of induction chemotherapy and radiationtherapy for more advanced disease led to good clinical results with reasonable toxicities. © 2014, Association of Otolaryngologists of India.
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页码：74 / 78
页数：4
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共 21 条
  • [1] Grau C., Johansen L.V., Jakobsen J., Et al., Cervical lymph node metastases from unknown primary tumours: results from a national survey by the Danish Society for Head and Neck Oncology, Radiother Oncol, 55, pp. 121-129, (2000)
  • [2] Friesland S., Lind M.G., Lundgren J., Et al., Outcome of ipsilateral treatment for patients with metastases to neck nodes of unknown origin, Acta Oncol, 40, pp. 24-28, (2001)
  • [3] Sinnathamby K., Peters L.J., Laidlaw C., Et al., The occult head and neck primary: to treat or not to treat?, Clin Oncol (R Coll Radiol), 9, pp. 322-329, (1997)
  • [4] Pignon J.P., Bourhis J., Domenge C., Et al., Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta- analyses of updated individual data. MACH-NC Collaborative Group, meta- analysis of chemotherapy on head and neck cancer, Lancet, 355, pp. 949-955, (2000)
  • [5] CohenEE L.M.W., Vokes E.E., The expanding role of systemic therapy in head and neck cancer, J Clin Oncol, 22, pp. 1743-1752, (2004)
  • [6] Mendenhall W.M., Amdur R.J., Palta J.R., Intensity-modulated radiotherapy in the standard management of head and neck cancer: promises and pitfalls, J Clin Oncol, 24, pp. 2618-2623, (2006)
  • [7] Argiris A., Induction chemotherapy for head and neck cancer: will history repeat itself ?, J Natl Compr Cancer Netw, 3, pp. 393-403, (2005)
  • [8] Jereczek-Fossa B.A., Jassem J., Orecchia R., Cervical lymph node metastases of squamous cell carcinoma from an unknown primary, Cancer Treat Rev, 30, pp. 153-164, (2004)
  • [9] Reddy S.P., Marks J.E., Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation, Int J Radiat Oncol Biol Phys, 37, pp. 797-802, (1997)
  • [10] Forastiere A.A., Goepfert H., Maor M., Et al., Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer, N Engl J Med, 349, pp. 2091-2098, (2003)
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