Abstract
This meta-analysis was designed to evaluate radiotherapy (RT) options preferable for neck cancer metastases from unknown primary sites (NCUP). Relevant articles published up through September 2015 were selected from EMBASE, Cochrane, PubMed and Web of Science. Thirty-three articles were identified, and relative risks (RRs) and 95% CIs for all pre-specified endpoints were calculated. Surgery plus RT showed an advantage for 5-year overall survival (OS) (RR 0.66, 95% CI 0.52–0.83, p = 0.0004) and neck recurrence (NR) (RR = 0.74, 95% CI 0.59–0.92, p = 0.008) compared to RT alone. The RRs for NR, primary tumor emergence (PTE), and 5-year disease free survival (DFS) for bilateral neck compared to ipsilateral neck irradiation were 0.61 (95% CI 0.41–0.91, p = 0.01), 0.44(95% CI 0.26–0.77, p = 0.004), and 0.81 (95% CI 0.64–1.03, p = 0.09), respectively. Irradiation of the neck plus potential primary tumor sites (PPTS) showed a benefit for 5-year DFS (RR 0.75, 95% CI 0.61–0.92, p = 0.005), NR (RR = 0.72, 95% CI 0.56–0.92, p = 0.009), and PTE (RR = 0.23, 95% CI 0.12–0.45, p < 0.0001) compared to neck-only irradiation. Adverse events occurred more frequently with bilateral neck plus PPTS irradiation. For NCUP, surgery plus RT of the bilateral neck and PPTS was associated with greater improvement of clinical outcomes.
Highlights
Neck cancer metastasis with an unknown primary site (NCUP) presents in patients with neck lymph node involvement in the absence of an identifiable primary tumor [1,2,3]
The relative risks (RRs) for neck recurrence (NR), primary tumor emergence (PTE), and 5-year disease free survival (DFS) for bilateral neck compared to ipsilateral neck irradiation were 0.61, 0.44(95% confidence intervals (CIs) 0.26–0.77, p = 0.004), and 0.81, respectively
The benefit to 5‐year DFS showed a similar trend (RR = 0.81, 95% CI 0.62–1.07, p = 0.13) (Figure 2B), though this did not reach statistical significance
Summary
Neck cancer metastasis with an unknown primary site (NCUP) presents in patients with neck lymph node involvement in the absence of an identifiable primary tumor [1,2,3]. Some investigators have recommended involved-field irradiation, such as ipsilateral neck irradiation only [7, 11,12,13,14], while others suggest extended field irradiation, including prophylactic irradiation of potential head and neck mucosal sites and both sides of the neck [1, 4, 6, 15]. The present meta-analysis was performed in an effort to identify the optimal treatment regimen for NCUP, focusing in particular on the optimal way to schedule RT
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