DÄ internationalArchive17/2009Metastases in the Absence of a Primary Tumor – Advances in the Diagnosis and Treatment of CUP Syndrome: In reply


Metastases in the Absence of a Primary Tumor – Advances in the Diagnosis and Treatment of CUP Syndrome: In reply

Dtsch Arztebl Int 2009; 106(17): 294. DOI: 10.3238/arztebl.2009.0294

Krämer, A

LNSLNS All correspondents discuss the therapy of prognostically favorable cervical lymph node metastases with squamous cell differentiation and an unknown primary tumor. Undoubtedly, the relatively rare subgroups of the CUP syndrome—which are mostly prognostically more favorable and suitable for specific therapies—deserve separate attention and detailed description. As we noted in our article, however, a detailed explanation of the therapeutic approaches in the numerous subgroups of CUP syndrome—as listed in a table of our article—would have exceeded not only the remit of the article but also the editorial rules in terms of word counts. For this reason, we restricted ourselves to delivering a detailed explanation of the standard procedures for disseminated, undifferentiated and adeno-CUP syndromes which account for 80% of cases. Further, we added pointers about the particular importance of the identification of patients who can be categorized in certain subgroups; we listed in a table the subgroups and recommended additional diagnostic tests and therapeutic strategies; and we mentioned diagnostioc and therapeutic guidelines of German Society for Hematology and Oncology (http://www.dgho.de), the European Society of Medical Oncology (http://www.esmo.org), and the National Comprehensive Cancer Network (http://www.nccn.org).

We agree with the correspondents that especially patients with CUP syndrome particularly benefit from interdisciplinary cooperation of almost all medical specialties in the form of regular, interdisciplinary tumor conferences. DOI: 10.3238/arztebl.2009.0294

Prof. Dr. med. Alwin Krämer
Klin. Kooperationseinheit für Molekulare
Hämatologie und Onkologie des
Dt. Krebsforschungszentrums u. der
Medizinischen Klinik u. Poliklinik V
Universität Heidelberg
Im Neuenheimer Feld 581, 69120 Heidelberg, Germany

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.