Laryngorhinootologie 2016; 95(07): 477-481
DOI: 10.1055/s-0042-100907
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Bedeutung des sekundär auftretenden Primärtumors bei einem zervikalen CUP-Syndrom

Significance of Secondary Mucosal Primaries in Patients with a Cervical CUP-Syndrome
A. M. Franzen
1   HNO - Plastische Operationen, Medizinische Hochschule Brandenburg, Campus, Neuruppin
,
A. Lieder
1   HNO - Plastische Operationen, Medizinische Hochschule Brandenburg, Campus, Neuruppin
,
A. Buchali
2   Klinik für Strahlentherapie und, Medizinische Hochschule Brandenburg, Campus, Neuruppin
› Institutsangaben
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Publikationsverlauf

eingereicht 03. Juni 2015

akzeptiert 12. Januar 2016

Publikationsdatum:
12. Mai 2016 (online)

Zusammenfassung

Fragestellung: Ziel der vorgestellten retrospektiven Analyse ist es, die Bedeutung des Primärtumors bei Patienten mit einem zervikalen CUP-Syndrom nach Abschluss von Diagnostik und Therapie zu ermitteln.

Patienten/Methoden: In die Untersuchung wurden 36 Patienten eingeschlossen, die wir zwischen 2001 und 2009 diagnostizierten. Die Primärtumorsuche umfasste eine Panendoskopie mit Mapping und Tonsillektomie, Sonografie und CT oder MRT. Es erfolgte eine multimodale, primär chirurgische Therapie der Metastasen und eine limitierte Bestrahlung der Schleimhäute des oberen Aerodigestivtraktes (IMRT, GHD 50 Gy). Die Daten zur Tumorkontrolle und die Therapie-assoziierte Toxizität wurden ermittelt.

Ergebnisse: Ein sekundärer Primärtumor der zervikalen Metastasen wurde bei keinem Patienten nachgewiesen. 6 Patienten verstarben an Fernmetastasen, ein Patient infolge der Chemotherapie, 4 an einem infraklavikulären Zweitkarzinom und 2 interkurrent. Eine Grad-4-Spättoxizität trat nicht auf, in 8% bestand eine Grad-3-Dysphagie.

Diskussion: Für die Frequenz sekundär auftretender Primärtumore bei einem CUP-Syndrom sind die Effektivität von Diagnostik und Therapie entscheidend. Unser Ergebnis zeigt, dass der Verzicht auf eine PET-Diagnostik sich nicht nachteilig auf die Manifestationsrate auswirkte bzw. durch die durchgeführte intensive Therapie kompensiert wurde. Die Prognose-entscheidenden Ereignisse (Fernmetastasen, infraklavikuläre Zweitkarzinome) traten unabhängig von sekundären Primärtumoren auf. Die elektive Therapie des mutmaßlichen Primärtumors sollte unter Berücksichtigung von Effektivität und Toxizität in ein individualisiertes Therapiekonzept einbezogen werden.

Abstract

Background: We discuss the significance of an occult primary in the prognosis of cervical carcinoma with unknown primary (CUP) after completion of diagnostic and treatment.

Patients/Methods: A series of 36 patients diagnosed between 2001 and 2009 underwent staging including panendoscopy, mapping and tonsillectomy, ultrasound and CT/MRI of the neck, thorax and abdomen. The patients recieved neck surgery followed by adjuvant radio-(chemo-)therapy of cervical fields as well as limited mucosal irradiation (IMRT, GHD 50 Gy). The results of tumor control and therapy-related toxicity were ascertained.

Results: A secondary primary of the cervical metastases was not detected during follow-up. 6 patients died from distant metastases and 1 from chemotherapy; 4 patients died from a different secondary tumour, 2 patients died intercurrently. We did not observe late toxicity but 8% of patients had Grade 3 dysphagia.

Discussion: Efficacy of diagnostic procedure and therapy are important in treating occult primary tumours in CUP. Our results show that omitting PET-CT, which was not available in diagnostic workup of the study-patients, did not impact negatively on the manifestation rate of mucosal primaries and/or was compensated for by intensive therapy. Distant metastases and infraclavicular secondary primaries had a negative impact for the survival. Elective therapy of a presumed occult primary tumour in CUP should be included into the therapeutic discussion considering its efficacy and toxicity.

 
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