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Between 1972 and 1986, 123 patients were treated with curative intent for a metastatic squamous cell carcinoma in cervical lymph nodes of an unknown primary. The lesions, staged according to the 1987 AJC classification were 24 N1, 59 N2, 34 N3 and 6 Nx. A hundred four patients underwent a cervical lymph node dissection and 9 an adenectomy. All these patients received post-operatively external beam therapy on the Waldeyer ring, the pharyngo-larynx, the cervical nodal areas (45 Gy); a boost (20 Gy) was delivered to nodes presenting with extracapsular spread. The 10 remaining patients were inoperable and were treated by radiation therapy alone to a total tumor dose of 70-75 Gy. In the group treated by surgery-radiation therapy, the 5-year overall nodal failure rate was 13.7% and it was 60% for the patients treated by radiation therapy alone. For the first group, this failure rate was correlated to the AJC stage (p = 0.01) and to the number of histologically involved nodes (p = 0.05). The failure rate was 7.7% if the node was clinically fixed versus 21% if it was not (p = 0.07). It was 18% when there was an extracapsular spread and 4.3% when it was absent (p = 0.11). Thirteen patients developed a subsequent primary lesion, in pre-irradiation volume in 5 cases (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Surgery is the standard treatment of tympano-jugular chemodectomas. Radiation therapy is used only for inoperable forms. Since the tumor most often does not regress completely after irradiation, radiation therapy is generally considered as palliative. From 1979 to 1988, 18 patients with this rare tumor were referred to the Necker Hospital Tumor Center for radiation therapy. These patients have now been followed for 2 to 11 years. Tumors were extensive (Fish Stage C and D) in 75% of the patients and half of these patients showed cranial nerve involvement in addition to the usual otovestibular anomalies. Three patients were referred for recurrent tumors and 7 patients had undergone surgery just prior to radiation therapy. Among the 11 patients treated with the tumor in place, 7 had more or less complete regression of symptoms and radiologic signs, 3 had no further progression of symptoms and radiologic signs and 1 had tumor progression and expired as the result of the disease. No patient receiving post-operative radiation therapy developed clinical or radiological evidence of recurrent tumor. Among the 18 patients treated, 2 died of intercurrent disease. Our experience shows that a dose of 45 Gy is suffisant, leaves no trace, and does not prevent subsequent surgery. In an extensive review of the literature, tumor growth stopped or regressed after radiation therapy in 90% of the patients reported. Therefore, if incomplete surgery or neurological operative sequelae seem unavoidable, we prefer radiation therapy to surgical management of this tumor.