Treatment strategy for neck metastasis from an occult head and neck primary

ABSTRACT

This study highlights our treatment policy in 26 cases of epidemeroid metastatic carcinoma in the neck from a primary deemed occult, after exhaustive examination of the Upper Aerodigestive Tract. Planned Radical Neck Dessection and post-operative radiotherapy has been the favored approach in all neck nodes deemed resectable and a loco-regional control rate of 64% was obtained using this combined modality approach. Pre-operative Radiotherapy was utilized in three cases with nodal disease of borderline resectability and loco-regional control was achieved in one case. Three cases of massive neck matastasis initially unresectable became amenable to surgical salvage after RT with concurrently administered chemotherapy. Only one of these remained disease free. Overall loco-regional control rate of 55% could be achieved in 20 evaluable patients followed up for 2 years-3 years [mean 30.5 months]. Regional failure were noted in 25% of patients while distant spread occurred in 15%, thus accounting for an overall failure rate of 40%. Manifest primary were documented in 20%, half of which could be salvaged and successfully controlled