Induction chemotherapy followed by radiotherapy in patients with cervical lymph node metastases from unknown primary carcinoma.

Abstract

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 3weeks of docetaxel (day 1.70mg/m(2)) and cisplatin (day 1.75mg/m(2)). Radiation therapy (RT) was started with in 10weeks of the last cycle of chemotherapy, and it was administered 5days per week. It was given in daily fractions of (1.8) Grays (Gy) of 2Gy and the total dose to the primary tumor was 70-74Gy. 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 50.6months, the estimated 2years OS rates were 71±6%, respectively. The median OS was 42months (95% confidence interval CI 8-65months). The recurrent-free survival rate at 2years 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 primary cancer has provided good overall and disease-free survival in all the patients with an acceptable rate of complications. The use of induction chemotherapy and radiation therapy for more advanced disease led to good clinical results with reasonable toxicities.