Survival of patients with metastatic breast carcinoma: importance of prognostic markers of the primary tumor

BACKGROUND: Women with metastatic breast carcinoma have a highly variable clinical course and outcome. Intrinsic genetic heterogeneity of the primary breast tumor may play a role in this variability and may explain it in part. Therefore, the authors tested the hypothesis that the characteristics of primary breast tumors are important determinants of prognosis and survival in patients with metastatic breast carcinoma. METHODS: The prognostic significance of the biology of the primary tumor for outcome in patients with metastatic breast disease was assessed in 346 patients with lymph node positive breast carcinoma who developed distant, recurrent disease. Traditional prognostic indicators (age, tumor size, number of involved lymph nodes, sites of recurrence, disease free interval [DFI], adjuvant treatments, estrogen receptor [ER] expression, progesterone receptor [PgR] expression, S-phase fraction [SPF], and DNA ploidy), together with three newer biologic markers (c-erbB-2, p53, and bcl-2) were assessed. Sites of recurrence were defined as nonvisceral (bone and locoregional lymph nodes) or visceral (lung, liver, brain, and other organs). RESULTS: The median duration of survival was 17.8 months (95% confidence interval, 15.2-21.5 months). Univariate analysis showed that age > 50 years, visceral disease, and shorter DFI were associated significantly with poor outcome (P < 0.05). In addition, the molecular phenotype of the primary breast tumor was significant, with primary tumors that showed ER negativity and PgR negativity, high SPF, aneuploidy, accumulation of p53 protein, and lower bcl-2 expression, together with c-erbB-2 overexpression, all associated with a poorer clinical outcome (P < 0.05). In a multivariate analysis, older age, visceral disease, shorter DFI, PgR negativity, high SPF, and lower bcl-2 expression were significant predictors of worse survival (P < 0.05). CONCLUSIONS: In addition to traditional risk factors, bcl-2 negativity was associated significantly with a worse clinical outcome. Biologic features of primary tumors were correlated independently with outcome after first recurrence in patients with metastatic breast carcinoma and may be used as indicators of prognosis in the metastatic setting.     

Metastasentherapie bei malignem Melanom mit unbekanntem Primärtumor

Malignant melanoma from unknown primary tumor is always a metastatic tumorous disease. The clinical presentation is often regional tumor manifestations in skin, subcutis, soft tissue or lymph nodes but may also show visceral metastases in lungs, liver, brain, bones, spleen or gastrointestinal manifestations. Diagnosis and treatment cannot always be separated. As multiple sites are frequently involved the individual treatment plan should be devised by an interdisciplinary tumor board after whole body staging. Documented local metastases in skin, soft tissue or lymph nodes are classified as stage III melanoma and treated accordingly. The prognosis has been shown to be equal to or even better than in cases with known primary tumor. Even after curative resection further recurrences are common but can often be re-resected with curative intent. Palliative treatment options, such as interventional procedures, radiotherapy, chemotherapy, novel kinase inhibitors and immunotherapy depend on tumor extent and the sites of the metastases.     

Prognostic factors in metastatic carcinoma of unknown primary

From January 1980 to June 1984, 70 patients with metastatic carcinoma of unknown primary treated with combination chemotherapy were analyzed for prognostic factors influencing objective response and survival. Suspicious germ-cell tumors and neuroendocrine tumors were excluded since patients with these malignancies tend to live longer than those with metastatic carcinoma of unknown primary. Objective response rate to combination chemotherapy was 28%. Median survival of all patients responding to combination chemotherapy was better than those not responding (16 v 3 months). In patients with good performance status, median survival was longer in responders than nonresponding patients (17 v 7 months). External lymph nodes or subcutaneous disease as the only site of disease and good performance status favorably influenced both objective response and survival, while the number of different metastatic sites favorably influenced only survival. Neutropenia and thrombocytopenia were appreciable but not fatal or a great cause of morbidity in those with good performance status. Thus, patients with metastatic carcinoma of unknown primary with good performance status or only external nodes or subcutaneous disease should be treated with combination chemotherapy regardless of age, histology, or number of different metastatic sites of disease.     

Diagnosis and treatment of unknown primary tumors

Cancers of unknown origin represent approximately 5% of all cancers and are therefore as frequent as some solid tumors such as gastric or pancreatic cancers. The diagnosis of cancer of unknown origin should be based on a detailed pathological examination including immunohistochemical techniques and electron microscopy; hormonal receptors should also be measured. Besides detailed medical history and physical examination, only a few additional tests should be carried out: routine chemistry including the assay of HCG, alphafoetoprotein and specific antigen of the prostate, chest X-ray, thyroid scan, mammography and abdominal CT scan. Other tests are generally not of sufficient specificity and sensitivity. Unknown primary tumors arising in the cervical area are frequently squamous cell carcinomas corresponding to occult primary tumors of the upper aerodigestive mucosae and are efficiently treated by cervicofacial radiotherapy or lymph node dissection. Women presenting with axillary lymph nodes with no obvious primary tumor should be treated according to the guidelines used for breast cancer. The patients with inguinal lymph nodes of unknown origin are usually treated with radiation therapy. The syndrome of germinal tumors of extragonadic origin corresponds to cases of undifferentiated or poorly differentiated carcinomas in patients under 50 years of age and with one of the following characteristics: involvement of the median organs, lung involvement, lymph node involvement or increase of alphafoetoprotein or HCG. The therapeutic approach recommended for these patients consists of the chemotherapeutic combination used for testicular cancer. For all other patients, the prognosis remains poor. Patients with local symptoms may be treated by radiation therapy; others may receive a combination of fluorouracil, doxorubicin and mitomycin.     

Unknown primary head and neck squamous cell carcinoma: molecular identification of the site of origin

BACKGROUND: Unknown primary head and neck squamous cell carcinoma (HNSCC) presents as a cervical lymph node metastasis without identification of the primary tumor, despite thorough diagnostic work-up that includes physical examination, computed tomography, esophagoscopy, laryngoscopy, bronchoscopy, and multiple surveillance biopsies. We investigated whether the site of origin of the primary tumor could be localized in the upper aerodigestive tract mucosa by detection of genetic alterations identical to those found in metastatic lesions. METHODS: Microsatellite analysis was performed on metastatic tumors obtained from 18 patients with unknown primary HNSCC. Histologically benign surveillance biopsy specimens were also analyzed. Patients were followed up to 13 years with continuing surveillance for primary mucosal tumors. Most patients were treated with neck dissection followed by radiation therapy to the affected neck and ipsilateral Waldeyer's ring. RESULTS: In 10 (55%) of the 18 patients, at least one histopathologically benign mucosal biopsy specimen from defined anatomic sites (i.e., most likely sites for an occult primary tumor) demonstrated a pattern of genetic alterations identical to that present in cervical lymph node metastases. One patient harboring genetic alterations in the base of the tongue and two patients harboring genetic alterations in a tonsillar fossa subsequently developed HNSCC in the identical or adjacent mucosal region; all three of the primary head and neck mucosal tumors that eventually appeared between 1 and 13 years later in these patients had genetic changes identical to those in the benign mucosal biopsy specimens and in the metastatic lymph nodes. CONCLUSIONS: These data support the hypothesis that histopathologically benign mucosa of the upper aerodigestive tract may harbor foci of clonal, preneoplastic cells that are genetically related to metastatic HNSCC and that such mucosal sites are the sites of origin of unknown primary HNSCC. Microsatellite analysis may represent a clinically useful tool for determining such sites.     

Intramammary lymph nodes

Radiographic, gross, and histopathologic studies on 158 whole breasts with primary operable carcinoma revealed intramammary lymph nodes in 28%, and of these breasts, 10% contained a metastatic deposit of carcinoma. Cancerous and noncancerous nodes were found in all quadrants of the breast with the positive ones being in the same quadrant as the carcinoma only 50% of the time. There was no demonstrable connection with the usual lymphatic drainage of the breast. With Stage II carcinoma, positive intramammary lymph nodes had no direct effect on prognosis, merely representing advanced disease and indicating a greater likelihood of axillary metastatic disease. There was a trend toward poorer prognosis in Stage I lesions with positive intramammary lymph nodes. This may indicate the Stage I carcinomas that have a similar prognosis as Stage II tumors. Conceivably, a Stage Ia, positive intramammary lymph node(s) but normal axillary lymph nodes, could be defined and used.     

A case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of cervix

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3-5% of all malignant neoplasms. CUP represents a heterogeneous group of metastatic tumors for which no primary site can be detected following a thorough medical history, careful clinical examination, and extensive diagnostic work-up. Several authors have reported poor prognosis of this malignancy, because there is no consensus on diagnostic guidelines and optimal therapy. Historically, chemotherapy has been the cornerstone of treatment for patients with CUP. We experienced a case of inguinal lymph node squamous cell carcinoma of unknown origin, accompanied with carcinoma in situ of the cervix. We report this case with a brief review of the literatures.     

Small cell carcinoma of unknown primary

Small cell carcinoma of unknown primary (SCUP) is an uncommon cancer that is usually diagnosed in the lymph nodes, liver, brain, or bone. Historically, this neoplasm has always been included with extrapulmonary small cell carcinomas (EPSCCs). The true incidence of SCUP is unknown but has been reported to comprise between 7% and 30% of EPSCCs. Although identification of small cell carcinoma can usually be made with histologic examination and immunohistochemical stains, differentiation between primary, metastatic, or other neuroendocrine tumors can be challenging. The prognosis of SCUP varies from a few months to several years depending on the location, extent of disease, and response to therapy. Combination chemotherapy with regimens similar to those used in small cell lung cancer (SCLC) form the backbone of therapy. However, multimodality therapy, including surgery and/or radiation therapy, in addition to chemotherapy may be used to treat localized disease. This review examines the biology, evaluation, and treatment of SCUP.     

Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary

BACKGROUND: Fine-needle aspiration (FNA) biopsy often is the first diagnostic procedure performed in patients with head and neck masses. When squamous cell carcinoma (SCC) is diagnosed, proper management and improved prognosis depends on identification of the primary tumor. Recent studies have indicated that human papillomavirus (HPV) infection is associated closely with oropharyngeal SCC and that these tumors have a distinct nonkeratinizing morphology. In this study, the authors explored the value of identifying HPV-related tumors in neck metastases to determine the origin of occult primary head and neck squamous cell carcinoma (HNSCC). METHODS: Thirty FNA biopsies of neck metastases from patients with HNSCC were recovered from the authors' files from 2004 to 2005. The primary sites included 13 oropharynx, 13 oral cavity, and 4 larynx/hypopharynx. All patients had corresponding tissue samples from the neck mass and the primary carcinoma. The FNA specimens and corresponding tissue samples were classified as either nonkeratinizing SCC (NKSCC) or keratinizing SCC (KSCC). In situ hybridization for HPV (HPV-ISH) was performed using ethanol-fixed, Papanicolaou-stained smears. A positive signal was defined as dark blue or black nuclear dots. Corresponding formalin-fixed, paraffin-embedded tissue sections also were processed for HPV-ISH. RESULTS: Twenty of the 30 FNA specimens were KSCC, and 10 were NKSCC. Eight of the 10 NKSCCs originated in the oropharynx, and 2 had nonoropharyngeal origin. HPV was detected in 7 of 10 NKSCCs. Ten of 30 (33%) FNA biopsies were positive for HPV, and 9 of those biopsies were metastatic from the oropharynx. Nonkeratinzing morphology or HPV-positive ISH in FNA samples significantly predicted oropharyngeal origin (P < .0069 and P < .0004, respectively). CONCLUSIONS: NKSCC in metastatic cervical lymph nodes predicted positive HPV-ISH and was strongly suggestive of an oropharyngeal primary tumor.     

子宫颈癌患者血清、盆腔淋巴结HPV检测及其相关性探讨

目的：检测宫颈癌患者原发灶、血清及其盆腔淋巴结中HPVDNA及亚型,探讨其相关性及临床意义。方法：选取16例行广泛全子宫切除术和盆腔淋巴结清扫术宫颈癌患者的原发灶组织、术前静脉血与盆腔淋巴结石蜡组织,运用PCR方法对上述标本进行HPVDNA及亚型的检测。结果：宫颈癌原发灶组织、血清标本中HPVDNA阳性率为50％（8／16）。16例盆腔淋巴结石蜡组织中13例为HPVDNA阳性（13／16,81．25％）,其中总共切除的133个淋巴结中60个为阳性（60／133,45．1％）,8例淋巴结HPVDNA阳性的病例其对应的原发灶组织也为阳性且两者亚型相同。盆腔淋巴结中的HPVDNA阳性率为45．1％（60／133）,显著高于病理证实的淋巴结转移率1．5％（2／133）。6例患者（6／16,37．5％）原发灶、血清、盆腔淋巴结同时均为HPVDNA阳性;2例患者（2／16,12．5％）原发灶、盆腔淋巴结中HPVDNA表达阳性,而血清为阴性;1例患者（1／16,6．25％）淋巴结、血清HPVDNA阳性,而原发灶为阴性;未发现原发灶、血清HPVDNA表达阳性而淋巴结为阴性的病例,而且以上HPVDNA阳性的病例同一个患者对应的HPV亚型也相同。结论：宫颈癌患者血清中HPVDNA检出率与临床分期无关。宫颈癌患者盆腔淋巴结的HPVDNA检测可提高病理诊断淋巴结转移的阳性率,并且淋巴结中HPVDNA的检出率与原发灶的分化程度相关。宫颈癌原发灶、血清、盆腔淋巴结中HPV感染可能存在相关性。     

Les entités anatomocliniques des CAPI relevant d’une prise en charge spécifique

Carcinoma of unknown primary (CUP) origin is a quite heterogeneous entity with a poor prognosis. It accounts for about 5% of all neoplasms. CUP is defined as a histologically confirmed diagnosis of malignancy in patients with unremarkable medical history, normal physical examination and routine blood tests, and normal computed tomography. Among CUPs, several subsets have been identified as likely to be associated with a better life expectancy after specific treatment. About 15% of CUPs correspond to those specific subtypes: metastatic disease of lymph nodes such as nodal midline distribution, isolated metastases to axillary nodes, cervical involvement with squamous histology or inguinal nodal involvement; peritoneal papillary serous carcinomatosis in women; metastatic neuroendocrine carcinoma; osteoblastic bone metastases with elevated PSA in men; a single metastatic site. Thus, ruling out the primary and recognizing one of these subsets appear necessary in the management of patients with CUP tumours.     

Management of patients with cancer of unknown primary site

Cancer of unknown primary site represents approximately 3% to 5% of all new cancer diagnoses. Adenocarcinomas account for 60% of all unknown primary cancers and poorly differentiated carcinomas or adenocarcinomas, for 30%. Historically, the prognosis for most patients with unknown primary tumors has been poor, with survival often less than 6 months from diagnosis. Recent advances in diagnostic techniques, including immunocytochemical and molecular genetic methods, have increased the probability of identifying a likely underlying tumor type. Based on clinical and pathologic features, approximately 40% of patients can be categorized within subsets for which specific treatment has been defined. Empiric therapy is an option for the remaining 60% of patients. In these patients, favorable prognostic factors for treatment response include tumor location in lymph nodes, fewer sites of metastases, younger age, and poorly differentiated carcinoma histology. Although experience remains limited, the incorporation of a taxane into empiric regimens appears to improve response rates and survival. A recent study of paclitaxel (Taxol), carboplatin (Paraplatin), and etoposide in 55 patients with cancer of unknown primary site reported an overall response rate of 47% and a median overall survival of 13.4 months. Investigations continue to explore new diagnostic techniques and novel therapeutic approaches.     

口腔鳞癌颈部淋巴结隐匿性转移的临床病理学特点及其意义

目的:探讨口腔鳞癌颈部淋巴结隐匿性转移的临床病理学特点及其临床意义。方法:对168例口腔鳞癌未探及颈淋巴结转移的患者的临床病理学因素与颈淋巴结转移的关系进行回顾性研究,并依据临床触诊及影像学结果将淋巴结分为三组,并对比各组淋巴结转移与临床病理学特点的相关性。结果:cN0期口腔鳞癌患者颈部淋巴结隐匿性转移与年龄、原发灶的大小、病理分化及生长方式存在统计学差异（P＜0.05）;牙龈癌及颊黏膜癌原发肿瘤越大发生颈部淋巴结隐匿性转移的几率越高。临床影像学未探及肿大淋巴结组其淋巴结阳性率与原发肿瘤大小及肿瘤生长方式密切相关（P＜0.05）,影像学肿大淋巴结小于1 cm组其颈部淋巴结阳性率与原发肿瘤病理分化程度密切相关。结论:口腔鳞癌颈部淋巴结的隐匿性转移是影响患者预后的重要因素,因此,明确隐匿性转移的危险因素,对选择合理的治疗方案、判断疗效及评估预后有重要作用。     

Zervikales CUP-Syndrom

Whenever the first diagnosis of a solid malignancy is found in lymphoid tissue and detection of the primary tumor during the initial diagnostic procedures is not successful, this syndrome is called CUP (cancer of unknown primary). When extensive diagnostic steps finally lead to detection of the primary, then an initial cup syndrome can be assumed in contrast to true CUP syndromes, where the primary tumor remains unrevealed. Most CUP metastases are adenocarcinomas, followed by poorly differentiated carcinomas, squamous cell carcinomas, and neuroendocrine tumors. Metastasis of unknown primaries occurring in lymph nodes of the neck region have a poor prognosis and is predominantly associated with worse prognosis than most other head and neck tumors, which however does depend on various factors. In this article, we introduce diagnostic steps with modern techniques like PET-CT/MRI, and review therapeutic options and prognosis in patients with cervical CUP syndrome.     

Recurrent epidermoid cancer of the anus

Of 83 patients with recurrent epidermoid cancer of the anus, 67 had tumors in the anal canal and 16 had tumors at the anal margin. Local pelvic or perineal recurrence after abdominoperineal resection of tumors in the canal had a poor prognosis. Median survival after combination chemotherapy and megavoltage irradiation was 14 months. With irradiation alone, median survival was 7 months, although nearly half of these patients had been treated with orthovoltage techniques. Untreated patients with visceral metastases had a median survival of 8 months, but no improvement in survival was seen after treatment with chemotherapy. In contrast, patients who had metastases in inguinal lymph nodes had a 55% 5-year survival rate after inguinal dissection. Patients with tumors at the anal margin did not have visceral metastases. This is an important difference between tumors arising in the canal and those arising at the anal margin. Local excision was satisfactory treatment for 90% of the patients who had local recurrence in the perianal skin; abdominoperineal resection was rarely required. Inguinal lymph node metastases from margin cancer are uncommon, but three of five such patients survived 5 years after groin dissection. A combination of 5-fluorouracil, mitomycin C, and radiation therapy was used for patients with pelvic recurrence after abdominoperineal resection of epidermoid cancer of the anal canal. In this study, there was no evaluation of the role of megavoltage irradiation alone at the recommended doses of 5500 to 6000 rad for these patients. Some patients with visceral metastases respond to combination chemotherapy, but median survival is not improved; evaluation of new chemotherapeutic regimens is required. Patients with canal tumors metastatic to inguinal nodes should be treated by groin dissection as their prognosis is relatively good. Local recurrence of tumors at the anal margin can be satisfactorily treated by further local excision; those patients with margin tumors metastatic to inguinal nodes require groin dissection.     

Prognosis in breast carcinoma utilizing plasma carcinoembryonic antigen and histologic characteristics of the primary tumor

Plasma carcinoembryonic antigen (CEA) concentrations in 128 patients with breast cancer were measured preoperatively. The data were related to the histologic features of the primary breast carcinoma and to the clinical follow-up data. Analysis of the plasma CEA values did not show a significant correlation with the histologic type and the histologic and nuclear grade of the primary tumor (n = 73) as well as to the presence or absence of keratin, necrosis, desmoplasia, tubule formation and mucin production. Furthermore, the results indicated that high CEA values (more than 10 ng/ml) may be associated with distant metastasis and not with the metastatic spread to lymph nodes. High CEA levels were also associated with reduced survival of the patients. This study confirms our previous report suggesting that high CEA levels are correlated with tumors of endodermal origin, whereas the CEA levels were within the normal range in the tumors of ectodermal origin. In agreement with other studies, however, it was found that the predictive value of plasma CEA concentrations in general is weak, so that the use of CEA measurement for prognosis is of limited value.     

A case of squamous cell carcinoma of unknown primary site with involvement of cervico-mediastinal lymph nodes successfully treated by chemoradiotherapy

A 70-year-old woman was admitted with cervicomediastinal lymph node metastases from squamous cell carcinoma of unknown primary site (Sq-CUPS). The patient was treated with 4 cycles of chemotherapy combining carboplatin and paclitaxel with subsequent radiation therapy. After serial treatment, a partial response was obtained, and the disease has not recurred for over 2 years. Chemotherapy with carboplatin and paclitaxel followed by sequential radiation therapy was suggested to be potentially useful for Sq-CUPS with involvement of cervicomediastinal lymph nodes, although this group of patients is generally regarded to have a poor prognosis.     

Site‐specific cancer deaths in cancer of unknown primary diagnosed with lymph node metastasis may reveal hidden primaries

Cancer of unknown primary site (CUP) is a fatal cancer ranking among the five most common cancer deaths. CUP is diagnosed through metastases, which are limited to lymph nodes in some patients. Cause‐specific survival data could guide the search for hidden primary tumors and help with therapeutic choices. The CUP patients were identified from the Swedish Cancer Registry between 1987 and 2008; 1,444 patients had only lymph node metastasis of defined histology (adenocarcinoma, squamous cell or undifferentiated). Site‐specific cancer deaths were analyzed by lymph node location and histology. Kaplan‐Meier survival curves were compared with metastatic primary cancer at related sites. Among the patients with metastasis to head and neck lymph nodes, 117 (59.1% of the specific cancer deaths) died of lung tumors. Patients with axillary lymph node metastasis died of lung and breast tumors in equal proportions (40.2% each). Also, squamous cell CUP in head and neck lymph nodes was mainly associated with lung tumor deaths (53.1%). With a few exceptions, survival of CUP patients with lymph node metastasis was indistinguishable from survival of patients with metastatic primary cancer originating from the organs drained by those nodes. The association between lymph node CUP metastases with cancer deaths in the drained organ and the superimposable survival kinetics suggests that drained organs host hidden primaries. Importantly, half of all site‐specific cancer deaths (266/530) were due to lung tumors. Thus, an intense search should be mounted to find lung cancer in CUP patients with lymph node metastases.     

食管癌锁骨上淋巴结转移放疗疗效及预后因素分析

目的 回顾性分析胸段食管癌锁骨上淋巴结转移患者的放疗疗效及其预后影响因素.方法回顾2005年1月-2009年12月经组织学证实的锁骨上淋巴结转移的胸段食管癌病例152例,其中食管原发灶采用放射治疗患者95例,手术治疗57例;食管原发灶治疗后锁骨上淋巴结转移81例,初诊时发现71例;141例患者锁骨上淋巴结行放射治疗,11例患者未行放射治疗.结果全组患者中位随访时间为17.5月(2～77月).放射治疗后近期疗效评价达CR、PR、NC及PD的分别为52.5％(74/141)、41.8％(59/141)、3.6％(5/141)和2.1％(3/141).1、2、3年生存率分别为51.3％、26.6％、17.3％.单侧转移与双侧转移患者1、3年生存率分别为54.0％、17.6％和26.7％、13.3％(P=0.033).转移灶放疗剂量≥60 Gy和＜60 Gy患者的1、3年生存率分别为61.5％、21.7％和12.5％、0(P＜0.01).单侧锁骨上区淋巴结转移的患者中,健侧锁骨上区预防照射与未行预防照射患者的1、3年生存率分别为53.7％、12.3％和56.3％、20.6％(P=0.939).多因素分析示患者的年龄、锁骨上淋巴结转移时间、锁骨上淋巴结转移时食管原发灶控制情况及是否合并内脏转移对预后的影响差异有统计学意义(P=0.007、P=0.009、P=0.008、P＜0.01).结论 放射治疗是食管癌锁骨上淋巴结转移的有效治疗手段;锁骨上转移灶放射治疗范围以累及野为宜,剂量60～70Gy;患者的年龄、锁骨上淋巴结转移时间、食管原发灶的控制情况及是否合并内脏转移对患者的预后有影响.     

原发灶不明的颈部淋巴结转移癌的治疗

目的：分析原发灶不明和颈部淋巴结转移癌治疗失败的原因，探讨治疗方法和技术。方法：共收集122例初治治疗的病例，单纯放射治疗（R）62例，单纯手术治疗（S）23例，单纯化疗（C）5例，手术加放射治疗（S＋R）20例，放射治疗加手术（R＋S）12例。手术治疗局部淋巴结切除术 18例，单侧颈淋巴结清扫术34例，双侧颈巴结清扫术3例。放射治疗94例中，全咽部和全颈部照射65例，全颈部照射9例，部分颈部照射20例。结果：全组5年总生存率和无瘤生存率分别为71．9％和36．5％，颈部转移癌未控和复发占45．9％，远地转移率为26．2％，原发灶发现占8．2％。影响颈部治疗失败的主要原因是N分期、综合治疗、全颈照射和肿瘤的放射敏感性。影响远地转移的主要原因是N分期、颈部淋巴结转移部位和原发灶出现。影响原发灶治疗失败的主要原因是颈淋巴结转移部位。结论：早期鳞癌或低分化部、未分化癌局部手术切除或活检术后直接进行放射治疗，晚期颈转移以放射治疗和手术综合治疗为主，可同时加化疗，而腺癌治疗以手术为主。对上中颈部低分化和未分化癌应采用全咽部和全颈部照射，除锁骨上淋巴结转移癌以外，原发灶不明的颈部淋巴结转移癌照射野至少应该包括全颈部。