演題番号 : P108-5
Cancer of unknown primary (CUP) is diagnosed at a metastatic stage, conferring unfavorable prognosis. Lymph node dissection for squamous cell carcinoma of CUP with localized inguinal lymph node metastases is recognized as a standard therapy, but this therapy has no consensus for cases with bilateral metastases.
A 68-years old man presented with bilateral inguinal swelling. Physical examination revealed elastic and hard tumors at both groin. Computed tomography showed lymph nodes enlargement at both groin, but no other tumor or lymph node swelling. Fluorodeoxglucose positron emission computed tomography demonstrated uptake in the both swelling lymph nodes without evidence of the other distant disease. Pathological findings revealed metastatic lymph node of squamous cell carcinoma without any evidence of primary tumor. He underwent radiation therapy and chemotherapy consisted of 5-fluorouracil and cisplatin. There was no viable cell pathologically at six months from chemoradiation, and no recurrence is defined for 12 months after the completion of treatment.
According to the guideline, groin dissection is recommended as a strategy for unknown primary squamous cell carcinoma with bilateral lymph node metastases, and priority of chemotherapy is less considered. But it has already been reported that the efficacy of systemic therapy for unknown primary squamous cell carcinoma. Moreover, several high frequent complications after surgery has been reported, such as surgical site infection, skin flap problems, seroma, edema of lower limbs, or hemorrhage. As this case, patients with this rare syndrome might not suffer from these morbidities, if we can control local or metastatic recurrence without operation.
Chemoradiation therapy may be feasible for cases of squamous cell carcinoma of CUP with bilateral inguinal lymph node metastases.