Radiat Oncol J.  2020 Mar;38(1):18-25. 10.3857/roj.2020.00108.

Failure patterns of cervical lymph nodes in metastases of unknown origin according to target volume

Affiliations
  • 1Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 3Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
  • 5Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
  • 6Cancer Research Institution, Seoul National University College of Medicine, Seoul, Korea
  • 7Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea

Abstract

Purpose
This study was aim to evaluate the patterns of failure according to radiotherapy (RT) target volume for cervical lymph nodes in metastases of unknown primary origin in head and neck region (HNMUO).
Materials and Methods
Sixty-two patients with HNMUO between 1998 and 2016 were retrospectively reviewed. We analyzed the clinical outcomes and primary site failure depending on the radiation target volume. The target volume was classified according to whether the potential head and neck mucosal sites were included and whether the neck node was treated involved side only or bilaterally.
Results
Potential mucosal site RT (mucosal RT) was done to 23 patients and 39 patients did not receive mucosal RT. Mucosal RT showed no significant effect on overall survival (OS) and locoregional recurrence (LRR). The location of primary site failure encountered during follow-up period was found to be unpredictable and 75% of patients with recurrence received successful salvage therapies. No significant differences in OS and LRR were found between patients treated to unilateral (n = 35) and bilateral neck irradiation (n = 21). Treatment of both necks resulted in significantly higher mucositis.
Conclusions
We found no advantages in OS and LRR of patients with HNMUO when mucosal sites and bilateral neck node were included in the radiation target volume.

Keyword

HNMUO; Pattern of failure; Radiotherapy
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