Management of cervical lymphadenopathies of unknown primary cancer

Abstract

Cervical lymphadenopathy of unknown primary tumour is a rare entity. In this situation, exhaustive diagnostic procedures are essential, including a comprehensive clinical examination, complete imaging, multiples biopsies and molecular testing. Localized disease cT0N1/N2a or low volumes N2b negative for Epstein-Barr virus can be treated either by surgery alone or unilateral neck radiation. For tumours N2b or above, either bilateral radiotherapy is proposed or chemoradiotherapy with cisplatin. Intensity-modulated radiotherapy is the standard technique of irradiation for the management of cervical lymphadenopathies of unknown primary origin. Dose regimens for postoperative or exclusive radiotherapy are detailed in this article, as well as the selection of prophylactic tumour and lymph node target volumes.