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April 1974

Occult Primary Tumor

Author Affiliations

Redwood and Green St Baltimore, MD 21201

Arch Otolaryngol. 1974;99(4):309. doi:10.1001/archotol.1974.00780030319019

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To the Editor.—A paper entitled "The Occult Primary Tumor" by Winegar and Griffin appeared in the Archives (98:159, September 1973). It is a representative anecdotal series that draws the conclusion that surgery is the best initial management in most cases, with no justification whatever for this conclusion. There is no indication as to how the decision was arrived at whether to treat any given patient with surgery, radiation therapy, or a combination of these treatments. The data in Table 6 shows a five-year survival for surgery alone of 44.4%, for the combination treatment 25%, and for radiation alone 6.9%. If the patients are indeed all the same, one can only conclude that adding radiation to surgery prejudices the result. It would appear far more likely that the combination of radiation therapy and surgery was used only when surgery was felt to be inadequate or in recurrence and that radiation

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