Concurrent chemoradiotherapy with or without induction chemotherapy for the management of cervical lymph node metastasis from unknown primary tumor.

Background: To determine the impact of concurrent chemoradiotherapy (CCRT) with or without induction chemotherapy over radiation alone for the treatment of patients of cervical lymph node metastasis from an unknown primary tumor.

Materials and Methods: A total of 96 patients with squamous cell histology of cervical lymph node metastases from unknown primary tumor were retrospectively reviewed. About 12 patients were treated with radiation alone (RT alone), 45 with CCRT, and 39 with induction chemotherapy followed by CCRT (ICCRT).

Results: Overall response rate (ORR) obtained with RT alone arm was 75%, whereas for CCRT, it was 86.7%. About 15.4% had a complete response (CR) after induction chemotherapy with 92.3% ORR after the completion of CCRT. At 2 years, the disease free survival (DFS) was 50% in RT alone, 73% with CCRT, and 62% with ICCRT, while the corresponding rates at 5 years were 50% for RT alone, 45% with CCRT, and 54% in ICCRT arm.

Conclusion: Though we obtained a high ORR with concurrent or induction chemotherapy arm over RT alone, there is no clear advantage in the DFS. The nonrandomized nature of this trial and the potential for selection bias should definitely be taken into account while drawing comparisons from this trial.