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Part 2 Site-Specifi c Indications and Techniques
SUGGESTED READINGS
Abbatucci JS, Boulier N, Laforge T, et al. Radiation therapy of
skin carcinomas: results of a hypofractionated irradiation schedule in
675 cases followed more than 2 years. Radiother Oncol 1989;14:113.
Ang KK, Peters LJ, Weber RS, et al. Postoperative radiotherapy for cutaneous melanoma of the head and neck region. Int J
Radiat Oncol Biol Phys 1994;30:795.
Ashby MA, Pacella JA, De Groot R, et al. Use of a radon
mould technique for skin cancer: results from the Peter MacCallum
Cancer Institute (1975–1984). Br J Radiol 1989;62:608.
Ballo MT, Bonnen MD, Garden AS, et al. Adjuvant irradiation for cervical lymph node metastases from melanoma. Cancer
2003;97:1789.
Bentzen SM, Overgaard J, ames HD, et al. Clinical radiobiology of malignant melanoma. Radiother Oncol 1989;16:169.
Bonnen MD, Ballo MT, Myers JN, et al. Elective radiotherapy
provides regional control for patients with cutaneous melanoma of
the head and neck. Cancer 2004;100:383.
Byers RM. e role of modi ed neck dissection in the treatment of cutaneous melanoma of the head and neck. Arch Surg
1986;121:1338.
Creagan ET, Cupps RE, Ivins JC, et al. Adjuvant radiation
therapy for regional nodal metastases from malignant melanoma: a
randomized, prospective study. Cancer 1978;42:2206.
de Wilt JH, ompson JF, Uren RF, et al. Correlation between
preoperative lymphscintigraphy and metastatic nodal disease sites
in 362 patients with cutaneous melanomas of the head and neck.
Ann Surg 2004;239:544.
Del Charco JO, Mendenhall WM, Parsons JT, et al. Carcinoma of the skin metastatic to the parotid area lymph nodes. Head
Neck 1998;20:369.
Fitzpatrick PJ. Skin cancer of the head—treatment by radiotherapy. J Otolaryngol 1984;13:261.
Fitzpatrick PJ. Radiation therapy for tumors of the skin of the
head and neck. In: awley SE, Panje WR, eds. Comprehensive manage-
ment of head and neck tumors. Philadelphia, PA: WB Saunders, 1987.
Fitzpatrick PJ, ompson GA, Easterbrook WM, et al. Basal
and squamous cell carcinoma of the eyelids and their treatment by
radiotherapy. Int J Radiat Oncol Biol Phys 1984;10:449.
Gillenwater AM, Hessel AC, Morrison WH, et al. Merkel
cell carcinoma of the head and neck: e ect of surgical excision and
radiation on recurrence and survival. Arch Otolaryngol Head Neck
Surg 2001;127:149.
Harwood AR. Conventional fractionated radiotherapy for
51 patients with lentigo maligna and lentigo maligna melanoma. Int
J Radiat Oncol Biol Phys 1983;9:1019.
Hietanen T, Nieminen S, Ekfors T, et al. Elective treatment
of regional lymph nodes in malignant melanoma. Strahlentherapie
1985;161:1.
Hliniak A, Maciejewski B, Trott KR.
number of fractions, overall treatment time and eld size on the
local control of cancer of the skin. Br J Radiol 1983;56:596.
Kearsley JH, Harris TJ, Bourne RG. Radiotherapy for super cial skin cancer at the Queensland Radium Institute: famine in the
land of plenty. Int J Radiat Oncol Biol Phys 1988;15:995.
e
in uence of the
Lejeune FJ. Surgery and radiotherapy for melanoma and skin
neoplasms. Curr Opin Oncol 1990;2:407.
Lovett RD, Pérez CA, Shapiro SJ, et al. External irradiation
of epithelial skin cancer. Int J Radiat Oncol Biol Phys 1990;19:235.
Mameghan H, Knittel T. Response of melanoma to heat and
radiation therapy—a review of the literature and experience from
e Prince of Wales Hospital, Sydney. Med J Aust 1988;149:474.
McCord MW, Mendenhall WM, Parsons JT, et al. Skin cancer
of the head and neck with clinical perineural invasion. Int J Radiat
Oncol Biol Phys 2000;47:89.
Medina JE, Ferlito A, Brandwein MS, et al. Current management of cutaneous malignant melanoma of the head and neck. Acta
Otolaryngol 2002;122:900.
Mendenhall WM, Parsons JT, Mendenhall NP, et al. T2–T4
carcinoma of the skin of the head and neck treated with radical irradiation. Int J Radiat Oncol Biol Phys 1987;13:975.
Morrison WH, Garden AS, Ang KK. Radiation therapy for
nonmelanoma skin carcinomas. Clin Plast Surg 1997;24:719.
Morrison WH, Peters LJ, Silva EG, et al. e essential role
of radiation therapy in securing locoregional control of Merkel cell
carcinoma. Int J Radiat Oncol Biol Phys 1990;19:583.
O’Brien CJ, Petersen-Schaefer K, Stevens G, et al. Adjuvant
radiotherapy following neck dissection and parotidectomy for
metastatic malignant melanoma. Head Neck 1997;19:589.
Overgaard J, Hansen PV, Von der Maase H. Some factors of
importance in the radiation treatment of malignant melanoma.
Radiother Oncol 1986;5:183.
Perez CA. Management of incompletely excised carcinoma of
the skin. Int J Radiat Oncol Biol Phys 1991;20:903.
Petrovich Z, Kuisk H, Langholz B, et al. Treatment results
and patterns of failure in 646 patients with carcinoma of the eyelids,
pinna, and nose. Am J Surg 1987;154:447.
Petrovich Z, Parker R, Luxton G, et al. Carcinoma of the lip
and selected sites of head and neck skin. A clinical study of 896
patients. Radiother Oncol 1987;8:11.
Sause WT, Cooper JS, Rush S, et al. Fraction size in external
beam radiation therapy in the treatment of melanoma. Int J Radiat
Oncol Biol Phys 1991;20:429.
Silva JJ, Tsang RW, Panzarella T, et al. Results of radiotherapy
for epithelial skin cancer of the pinna: the Princess Margaret
Hospital experience, 1982–1993. Int J Radiat Oncol Biol Phys
2000;47:451.
Solan MJ, Brady LW, Binnick SA, et al. Skin cancer. In: Perez
CA, Brady LW, eds. Principles and practice of radiation oncology,
2nd ed. Philadelphia, PA: JB Lippincott Co., 1992.
S
tevens G, ompson JF, Firth I, et al. Locally advanced mel-
anoma: results of postoperative hypofractionated radiation therapy.
Cancer 2000;88:88.
Tapley N . Radiation therapy with the electron beam. Semin
Oncol 1981;8:49.
Tapley N, Fletcher GH. Applications of the electron
beam in the treatment of cancer of the skin and lips. Radiology
1973;109:423.
Trott KR, Maciejewski B, Preuss-Bayer G, et al. Doseresponse curve and split-dose recovery in human skin cancer. Radi-
other Oncol 1984;2:123.
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Neck Node Metastasis from
Unknown Primary
Key Points
• A thorough search for a primary site is a requisite
part of the staging workup and should include an
examination under anesthesia, appropriate biopsies
of subsites within the pharyngeal axis, and/or tonsillectomy.
• Radiation is recommended in either the frontline or
the adjuvant setting to obtain or maintain regional
control.
• In the absence of randomized trials, radiation target
volumes remain controversial. Many centers recommend comprehensive treatment to bilateral neck
lymphatics and putative sources of the primary site,
principally the nasopharynx and oropharynx with or
without the hypopharynx.
• Early data of IMRT suggest favorable outcomes with
regard to disease control and reduced toxicity.
TREATMENT STRATEGY
e diagnosis is usually established by a nodal biopsy or
aspiration, which should be followed by an examination
under anesthesia, with biopsy of suspicious potential primary sites. Tonsillectomy is usually performed in the absence
of suspicious lesions. Historically, a er completion of the
workup, a neck dissection was performed o en followed
by postoperative radiation when more than one node is
involved, particularly in the presence of extranodal extension.
e more common practice today, as many patients present
with human papillomavirus (HPV)-associated disease, is to
begin with radiation, with concurrent chemotherapy in the
presence of large nodal volume or CT evidence of extranodal
extension, and perform a neck dissection if the nodal disease
does not regress completely. Many centers currently recommend irradiation to the pharyngeal axis and the bilateral neck.
Some favor omitting the larynx and hypopharynx. Intensitymodulated radiation therapy (IMRT) may allow comprehensive bilateral therapy while providing parotid sparing.
Irradiation to the ipsilateral neck alone is indicated if the
histologic ndings (e.g., adenocarcinoma) or nodal location
(e.g., submenal, submandibular, supraclavicular) indicate a
low probability of a primary along the pharyngeal axis. It
may also be considered when, because of advanced age or
poor medical condition, the patient is not expected to tolerate large-volume irradiation to the pharyngeal axis but residual disease is present or the probability of progression in the
neck is high (e.g., presence of extracapsular nodal disease).
Close observation can be considered in patients who
had neck dissection, which reveals low risk for recurrence
(i.e., a single lymph node <3 cm without extracapsular extension [ECE]).
COMPREHENSIVE RADIOTHERAPY
Target Volume
Initial Target Volume
e initial target volume is composed of oropharynx,
nasopharynx, and bilateral neck nodes when the clinical
or histologic features suggest primary site origin from the
oropharynx or nasopharynx. For example, a nonsmoker
with a level II node, particularly with cystic squamous
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Part 2 Site-Specifi c Indications and Techniques
cell carcinoma, nonkeratinizing “nasopharyngeal-like,” or
undi erentiated carcinoma or carcinoma that is positive
by HPV in situ hybridization or p16 immunohistochemical
assay would strongly favor an oropharyngeal primary tumor.
e presence of involved upper posterior cervical (level V)
nodes suggests a nasopharyngeal primary.
In other cases, the initial target volume encompasses nasopharynx, oropharynx, hypopharynx, and bilateral neck
(see Case Studies 16-1 and 16-2).
nodes
e boost or high-dose volume encompasses the
involved nodal bed.
Case
Study
16-1
aspiration from this node showed poorly di erentiated squamous cell carcinoma. A computed tomography (CT) scan
con rmed the lymphadenopathy in the right jugular chain.
An examination under anesthesia showed no abnormalities except for leukoplakia on both true vocal cords. Biopsy
specimens were taken from the nasopharynx, tonsils, base
of tongue, and both true vocal cords. All results were negative for malignancy. e biopsy specimens of the vocal cords
showed only hyperkeratosis. e patient then underwent a
right modi ed radical neck dissection. Histologic examination showed poorly di erentiated squamous cell carcinoma in
two of the 13 lymph nodes, one located in the midjugular area
and the other one at the midposterior cervical chain. ere
was ECE from the midjugular node. Stage: T0 N2b M0. Subsequently, this patient received postoperative radiotherapy.
e entire pharyngeal axis and the upper and mid
neck were treated bilaterally with opposed–lateral elds, as
shown in Figure 16.1. e lower neck nodes were treated
with an anterior appositional eld. A total dose of 54 Gy was
delivered, and then the right neck received an additional
irradiation dose of 63 Gy with an appositional electron eld.
A 67-year-old man consulted his physician for
mild hoarseness. He was found to have leukoplakia on both true vocal cords. Examination
of the neck revealed a 2-cm mobile lymph node
in the right midjugular region. A ne-needle
Setup and Field Arrangement
The patient is immobilized in a supine position with a
thermoplastic mask. Marking of surgical scar facilitates
portal design. For 3D radiotherapy, the initial target
volume is irradiated with lateral–opposed photon fields.
• Superior border: at mid sphenoid sinus or at the bottom of
the pituitary fossa to encompass the roof of the nasopharynx.
• Anterior border: include posterior third of the nasal cavi-
ties and the anterior tonsillar pillars; 1-cm fall-o for the
dissected neck.
Figure 16.1
Case
Study
16-2
mens of both tonsils, the nasopharynx, base of tongue, vallecula, and pyriform sinuses were negative for neoplasm.
e patient then underwent bilateral neck dissections. e
le neck dissection revealed four of 34 nodes positive for
poorly di erentiated carcinoma (levels 2 and 3), whereas
the right neck dissection was negative for metastases. Stage:
T0 pN2b M0. He received radiotherapy to both necks and
the pharyngeal axis.
A 50-year-old man presented with bilateral
cervical adenopathy (multiple le neck nodes
and a 1.5-cm right neck node). He underwent
an examination under anesthesia, which did
not reveal any primary tumor. Biopsy speci-
Figure 16.2A shows a digitally reconstructed radiograph of
the opposed–lateral eld is shown. Radiation was delivered
with 6-MV photons in 1.8-Gy fractions to a dose of 54 Gy,
with an o –spinal cord reduction to 41.4 Gy. A 3-mm tissue equivalent bolus material was placed over the scar. e
posterior strips were supplemented with 9-MeV electron
beams. Wedges were used to obtain a more homogenous
distribution. Isodose distribution of the parallel photon
beams at the level of the upper (Fig. 16.2B) and mid necks
(Fig. 16.2C) is shown. e low neck was treated with a
separate anterior eld.
Chapter 16 Neck Node Metastasis from Unknown Primary
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A B
267
C
Figure 16.2A-C
• Posterior border: b
posteriorly to encompass the scar.
• Inferior border: just above the arytenoids or below the cri-
coid cartilage, depending on whether the hypopharynx is
part of the target volume.
A matching anterior appositional photon eld is used to treat the
cervical and supraclavicular nodes below the lateral portals. e
boost dose is usually delivered through one or two lateral appositional electron elds. e electron energies are selected based on
the depth required to reach the target bed. If the depth is beyond
the reach of electrons, glancing photon elds can be used.
ehind the spinous processes or more
Dose
e dose to the initial target volume is 54 Gy in 30 fractions.
e boost dose is an additional 6 to 10 Gy in three to ve
fractions in the postoperative setting. e boost dose can be
delivered as a concomitant boost as second daily fractions,
with a minimal interval of 6 hours, during the last week of
the basic treatment course. In cases of gross nodal disease,
a boost dose of 16 Gy in eight fractions (or in 10 fractions
if boost dose is given as second daily fractions) is delivered.
Intensity-Modulated Radiation Therapy
Planning
Most patients are now treated with IMRT to spare parotid
function (see Case Study 16-3). In the event of gross nodal
disease, the nodes with 1-cm margin are outlined as high-dose
clinical target volume (CTVHD or CTV1). e neck compartments outside CTVHD with a 2-cm margin are delineated as
CTVID (CTV2). e remaining ipsilateral nodal levels (IB, II,
III, IV, and V) on the ipsilateral side, retropharyngeal nodes,
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Part 2 Site-Specifi c Indications and Techniques
Case
Study
16-3
biopsies of the larynx, base of tongue, pharyngeal wall, and
nasopharynx, revealed normal-appearing mucosa. CT scan
showed two enlarged lymph nodes in level II with additional subcentimeter nodes. Stage: T0 N2b M0.
He was treated with IMRT to a dose of 66 Gy to the
involved nodes with margin (CTVHD—red), 60 Gy to
the remaining uninvolved ipsilateral upper neck nodes
(CTVID—green), and 54 Gy to clinically uninvolved
A 50-year-old man, with no history of tobacco
consumption, presented with an asymptomatic le neck mass. A ne-needle aspiration
of this mass revealed squamous cell carcinoma. An examination under anesthesia, with
contralateral nodes and mucosa of the pharyngeal axis
(CTVED—yellow) in 30 fractions. e spinal cord dose was
limited to <45 Gy.
Figure 16.3 shows CTVs at the levels of the nasopharynx (Fig. 16.3A); superior base of tongue, tonsillar
fossae, soft palate, and retropharyngeal nodes anterior to
C1 vertebra (Fig. 16.3B); mid tongue base, tonsillar fossae, and left level II nodal region at subdigastric muscle
(Fig. 16.3C); and inferior base of tongue and bilateral
level II nodal level (D). Note that the ipsilateral level
Ib is included in the CTVID (60 Gy). Figures 16.3E–G
show axial, sagittal, and coronal dose distributions,
respectively.
A
C
Figure 16.3A-D
B
D
Chapter 16 Neck Node Metastasis from Unknown Primary
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269
E
G
Figure 16.3E-G
F
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Part 2 Site-Specifi c Indications and Techniques
and contralateral nodal levels II to V are contoured as CTVED
(CTV3). e pharyngeal axis (including the hypopharynx
and larynx when indicated) is also delineated as CTVED
(see Case Study 16-4).
In cases where the nodal disease has been surgically
excised, the original involved nodal bed with a 1- to 2-cm margin is outlined as CTVHD, the remaining dissected neck is outlined as CTVID, and CTVED is similar to the de nitive setting.
With IMRT, the preference is to deliver treatment in
30 fractions to all target volumes. With gross nodal disease, the prescribed doses are 66 Gy to CTVHD, 60 Gy to
CTVID, and 54 Gy to CTVED. An electron boost of 2 to 4 Gy
Case
Study
16-4
pharyngeal axis (bilateral tonsils, base of tongue, posterior
wall), junction of oropharynx and hypopharynx (including
vallecula and vestibules of the pyriform sinuses), larynx,
and remaining cervical nodes as CTVED (54 Gy).
Figure 16.4A shows contours delineated on an axial
image at nodal level III. e larynx was outlined as a separate CTVED to allow for the exibility of planning to minimize hot spots in this structure. Figure 16.4B–D shows
isodose distributions at axial sections through the levels
A 56-year-old man presented with T0 N2b
squamous cell carcinoma of the le neck and
received IMRT. e involved nodes and margin were outlined as CTVHD (69 Gy), the margins around CTVHD as CTVID (60 Gy), and the
in one or two fractions can be delivered to the gross nodal
dis
ease to bring the dose to 70 Gy. In the postoperative
setting, the prescribed doses are 60 Gy to CTV
higher-risk regions may receive 63 to 66 Gy), 57 Gy to
CTVID, and 54 Gy to CTVED. In the presence of extensive
ECE or a er only nodal excision, a smaller volume may
receive a slightly higher dose (see Case Study 16-5). A thin
bolus may be used when the nodal disease is close to the
skin (see Case Study 16-6).
Dose Specifi cation
See “General Principles.”
of the inferior nasopharynx, the midoropharynx, and the
junction of oropharynx and hypopharynx (including vallecula and vestibules of the pyriform sinuses), respectively.
e contralateral (right) jugular fossa was excluded in the
target to allow more sparing of the contralateral parotid
gland. CTVHD received 66 Gy with IMRT and then supplemented with 3 Gy in two fractions by appositional 12-MeV
electrons (delivered as a second daily fraction). Lower
nodal levels III and IV were treated with a matched anterior
beam to 50 Gy (with a small midline block to 40 Gy and a
full midline block for the remaining 10 Gy). e patient
showed complete response and did not undergo neck dissection. He remains without disease for 3½ years and has
only grade 1 xerostomia.
(smaller
HD
AB
Figure 16.4A,B
Chapter 16 Neck Node Metastasis from Unknown Primary
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C D
Figure 16.4C,D
271
Case
Study
16-5
the right pyriform sinus, and a right neck dissection. All
the results of the mucosal biopsies (including the tonsil
specimens) were negative, and the neck dissection revealed
squamous cell carcinoma in two level II nodes (largest
node measuring 3 cm). He was treated with postoperative IMRT, which was delivered to the entire cervical lymphatics (including level IV and supraclavicular nodes) in
30 fractions.
Contours and isodose distribution are shown on a coronal
image (Fig. 16.5). CTVHD, encompassing the right level IIA
region with margin, received a dose of 60 Gy (blue contour).
An additional dose of 4 Gy in two fractions was delivered
to level II nodal region, with 12-MeV electron beam. e
remaining dissected right neck (CTVID) received a dose of
57 Gy (maize). e le neck, pharyngeal axis, and larynx
were de ned as CTVED and received a dose of 54 Gy. CTV
was outlined as three separate structures for exibility of
planning. Notably, portions of the larynx received a slightly
A 66-year-old man, former smoker, presented
with right level II adenopathy. He underwent
an examination under anesthesia with bilateral tonsillectomies, biopsies of both sides of
the nasopharynx and base of tongue as well as
ED
lower (within 5%) dose. He is without disease over 3 years
from his treatment. He does have corrected chemical hypothyroidism and minimal xerostomia.
Figure 16.5
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Part 2 Site-Specifi c Indications and Techniques
Case
Study
A 45-year-old man presented with a 4-cm le
neck mass. It was thought to be a branchial
cle cyst and was excised. Histologic exami-
16-6
nation, however, revealed squamous cell carcinoma. Complete workup showed no primary
lesion, and he was treated with IMRT.
An axial CT image is shown with contours and isodose
distribution (Fig. 16.6). CTVHD (green), delineated on the
basis of original imaging, received a dose of 63 Gy. CTV
(purple) represented margin around the involved nodal bed
that encompassed the nodal levels at higher risk. e contour was drawn to just under the skin surface at the surgical
scar (wired), and bolus was applied for treatment planning.
CTVED included the contralateral neck nodes (maize) and
putative mucosal sites (blue) at the level shown. e doses
delivered to CTVID and CTVED were 57 Gy and 54 Gy,
respectively, in 30 fractions.
Background Data
ID
Figure 16.6
Table 16.1
Irradiation Site
Neck only 0/2 2/4 1/6 4/8 7/20
Nasopharynx and oropharynx 1/11 0/3 1/6 2/6 4/26
Nasopharynx, oropharynx,
and hypopharynx
Total 2/23 2/22 4/24 6/24 14/93
Note: The 14 patients who failed therapy are shown by both the type of surgical procedure performed and the irradiation technique used. A greater proportion
of patients failed after having received irradiation to the neck only (7/20), as compared to those treated to the naso-oropharynx (4/26) or nasopharynx,
oropharynx, and hypopharynx (3/47). No correlation is seen between the incidence of failure and the type of surgery used.
From Carlson LS, Fletcher GH, Oswald MJ. Guidelines for radiotherapeutic techniques for cervical metastases from an unknown primary. Int J Radiat Oncol
Biol Phys 1986;12:2101–2110, with permission.
Therapy Failures by Neck Surgery and Irradiation Technique
Incisional
Biopsy
1/10 0/15 2/12 0/10 3/47
Excisional
Biopsy
Modifi ed Neck
Dissection
Radical Neck
Dissection Total
Chapter 16 Neck Node Metastasis from Unknown Primary
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Table 16.2
First Author (yr) No. of Patients Neck Treatment
Regional Failure and Mucosal Site Occurrence: Literature Review
Regional
Failure (%)
Radiation
Technique
Primary Site
Occurrence (%)
Grau (2000) 250 X—224 X—50% M—224 M—13%
X + S—26 X + S—38% (5-yr a) N—26 N—23%
Weir (1995) 144 X—144 X—49% (5-yr a) M—59 M—2%
N—85 N—7%
Colletier (1998) 136 X + S—136 X + S—9% (c) M—120 8%
N—16
Erkal (2001) 126 X—56 A—22% (c) M—119 M—10%
X + S—70 N—7 N—14%
Maulard (1992) 113 X + S—113 X + S—14% (c) M—113 10%
Ligey (2009) 95 X + S—95
A—31% (c) M—36 M—6%
(16 sampled)
N—59 N—12%
Boscolo-Rizzo (2007) 90 X + S—90 A—31% (5-yr a) M—90 9%
Marcial-Vega (1990) 72 X—41 X—54% (c) M—53 M—25%
X + S—31 X + S—58% N—19 N—16%
Patel (2007) 70 S—19 A—20% N—60 11%
X + S—60
Reddy (1997) 52 X—21 X—52% (c) M—36 M—8%
X + S—31 X + S—10% N—16 N—44%
X, radiation alone (following biopsy); X + S, radiation and neck dissection; A, all patients; M, radiation to bilateral necks and mucosal sites; N, radiation to the
involved neck only; 5-yr a, 5-year actuarial; c, crude rate.
Table 16.3
Results of IMRT for the Treatment of Carcinoma Metastatic to the Neck From Unknown Primary
First Author (yr) Patient Number Median Follow-up (mo)
Klem (2008) 21 24 90% (2-yr)
Madani (2008) 23 17 91% (crude)
Lu (2009) 18 35 89% (2-yr)
Frank (2010) 52 44 94% (5-yr)
Chen (2010) 27 25 92%
a
Local-regional control.
Regional Progression
Free Survival
a
(2-yr)
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