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[Treatment of metastatic neck squamous cell carcinomas with unknown primary].

INTRODUCTION
Treatment of metastatic neck squamous cell carcinomas of unknown primary is one of the most serious problems in head and neck oncology.


MATERIAL AND METHODS
Fifty-one patients were analyzed during the period 1977-1997. All patients underwent clinical examination of head and neck, hematological and laboratory tests, X-ray of paranasal sinuses, esophagus and lungs, scintigraphy of the thyroid gland, epipharyngoscopy, esophagoscopy and laryngotracheobronchoscopy, biopsy of suspected changes and blind biopsy of suspected regions (epipharynx, tongue base, piriform sinus), ipsilateral tonsillectomy (17 patients), examination of gastrointestinal tract, kidneys, prostate, testicles, and breasts and ovaries, respectively.


RESULTS
Almost half of metastases developed in the II level of the neck (49.01%; 25/51). Most metastases were 3-6 cm in diameter (N2)--60.76% (31/51). Forty patients were surgically treated by various neck dissection methods and postoperative radiotherapy (60 Gy). Palliative radiotherapy was applied in patients with inoperable metastases. Eighteen patients had a five-year disease free survival (35.29%).


DISCUSSION
Metastases localized in the II and III levels of the neck and in the upper two-thirds of the V level, should be primarily treated by neck dissection. Lymph nodes up to 3 cm in diameter (N1) are operated by a modified radical neck dissection. Lymph nodes over 3 cm (N2) and 6 cm in diameter (N3) are operated by radical or extended radical neck dissection.


CONCLUSION
Primary surgery plus postoperative radiotherapy provide satisfactory results in therapy of metastatic squamous cell carcinomas of the neck with unknown primary.