Recent series of patients treated for cervical lymph node metastasis from an occult primary site show disease-specific survivals at 5 years of 60 to 74%, with overall survival of 35 to 60%.16'19'22 These, and other studies, have confirmed that neck control and survival are determined by the extent of the neck disease, including the N stage, node fixation, extracapsular spread, and the number of involved nodes.10'16'19'21'22 Five-year survival rates by N stage are reported at 60 to 62% for N1, 40 to 50% for N2, and 19 to 38% for N3 groups.19'21

Whether survival is influenced by the eventual manifestation of the primary site above the clavicle remains uncertain. Primary lesions will eventually manifest in about 16% of patients treated for cervical metastasis from an occult primary, with nearly 50% of these presenting within the first 2 years.25 Significantly more primaries manifest in patients who have not received radiotherapy as part of their management (27% vs 6% with radiation).25 A review conducted at M.D. Anderson Hospital failed to show any effect of an eventual primary site discovery on survival or neck control at 5 years compared with those whose primary site remained occult.25 The same conclusion has been reached by others.2'10

Not all would agree with this conclusion, however. Several reviews provide some evidence to support the view that the ulti

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