[Prognosis and possibilities of treatment of inaugural metastases].

Prognosis depending on clinical presentation The prognosis of carcinomas of unknown primary site (CUP) is poor, with median survival of 8 months. Prognosis is better for specific clinical forms. Recent predictive models rely on the general status of the patient and simple biological parameters (lacticodehydrogenase or alkaline phosphatase levels) refine the prognostic assessment of CUP except in certain specific clinical forms. Treatment of specific clinical forms Cervical node metastases revealing an unfound epidermoid carcinoma require surgical node excision and radiotherapy. Axillary node metastases in woman require lymph node excision and systemic adjuvant therapy, similar to that used in breast cancer. The management of peritoneal serous papillary carcinomatosis in women consists in chemotherapy as in ovarian cancer, combined with debulking surgery. Median line syndrome requires radiotherapy or chemotherapy (with a cisplatin-etoposide combination or the regimen used for treatment of germ-cell tumours). Other therapeutic possibilities Excluding these forms, no chemotherapy regimen is a gold standard. Best supportive care is an acceptable option. There is little data on locoregional treatments.