Metastatic Cervical Squamous Cell Carcinoma from Occult Head and Neck Primary: A ‘Conservative’ Approach

Salvage treatment (including neck dissection, adjuvant postoperative irradiation, and radiotherapy) was attempted in eight patients. Two patients remain disease-free at 13 and 45 months following salvage therapy, one is alive with disease two months after salvage therapy, and the remaining five patients died. Salvage was unsuitable because of advanced regional and distant disease in five patients, four of whom died within one month.

Five patients’ cancers recurred at distant sites a median of nine months following initial treatment, and four of these have died.

Of the total study cohort of 70 patients, cancer recurred in 27 patients following initial treatment. Of these, five remain disease-free following salvage treatment. Disease-specific survival and overall survival at five years were 62% and 56%, respectively, with a trend toward worse disease-specific survival in patients with pN3 stage. In total, 12 of 70 patients suffered complications, with wound-related problems being most frequent.

Study Conclusions

Dr. Patel noted that SCCUP has a relatively good prognosis, with disease-specific survival rates approaching 70%, and for this reason, many centers adopt aggressive locoregional treatment directed against the most likely mucosal sites based on the location of involved nodes.

Some centers advocate use of aggressive treatment protocols to reduce rates of primary tumor emergency and contralateral neck failure. However, these rates of failure were low in our study and equivalent to those using more aggressive therapies, Dr. Patel said. In our series, salvage was not always successful and this was particularly the case in those with regional failure. Thus, the concept of reserving additional therapy for salvage is not supported by the low rate of successful salvage in our series.

He further noted that their results suggest that more aggressive therapy should be offered to selected patients, namely those with bulky neck disease (pN2 and pN3) and, in particular, patients with macroscopic ECS.

©2007 The Triological Society