Prognostic impact of second primary tumors in head and neck cancer

Abstract

The incidence of Second Primary Tumors in the upper aerodigestive tract varies from 5 to 30 %. Most of them are located either in the same anatomical region or in the lungs, and are related to a poor overall survival. Our objective is to assess the incidence of Second Primary Tumors, factors related to its outcome, frequent associations, and impact on overall survival. 27 patients with Second Primary Tumors were reviewed out of 307 with head and neck cancer, between 2002 and 2011. Patients had a minimum follow-up period of 3 years, or until their death after the last treatment. Sex: 85.2 % were male; male:female ratio of 23:4. The mean age of appearance for the primary tumor was 66.8 years. Only 1 patient had a synchronous Second Primary Tumor, while 26 had metachronous Second Primary Tumors. Second neoplasms were grouped into synchronous and metachronous for statistical analysis. The following parameters were considered: age at diagnosis of the first tumor, gender, smoking and persistence of the habit, primary tumor's location in the larynx, association between two squamous cell carcinomas (index and second primary tumor), and radiotherapy for the primary tumor. The incidence of Second Primary Tumors was 8.79 %. Overall survival of metachronous tumors was 95 months (7.9 years). The primary tumor's location that prevailed when developing a Second Primary Tumor was the larynx. Regarding the histology, the most common association was head and neck squamous cell carcinoma with head and neck squamous cell carcinoma (9 patients). The Second Primary Tumor was the cause of death in 51.9 % of the patients and its most frequent location was the lungs. 19 patients underwent radiotherapy. Second Primary Tumors are common in the head and neck. The authors would like to enforce the importance of an extended follow-up, since second neoplasms worsen considerably the patient's prognosis. Patients who keep on smoking after treatment decrease even more their overall survival.

Transoral robotic surgery for tonsillar cancer: Addressing the contralateral tonsil

“…The theory postulates that multiple cancers may arise independently in the upper aerodigestive tract (UADT) because of prolonged exposure to carcinogens, such as tobacco smoke and alcohol. Second primary malignancies are present in up to 36% of patients with UADT cancer within 20 years of their original diagnosis . Synchronous tumors occur simultaneously with the index cancer and are present in approximately 4% of cases .…”

“…Second primary malignancies are present in up to 36% of patients with UADT cancer within 20 years of their original diagnosis. 2,3 Synchronous tumors occur simultaneously with the index cancer and are present in approximately 4% of cases. 4 The oropharynx is one of the most common sites of synchronous UADT cancers, with the tonsils being the most common site affected.…”

Metakroni karcinom larinksa – prikaz slučaja

“…Pojava novih tumora može biti sinkrona, kada se tumor dijagnosticira unutar 6 mjeseci od dijagnoze inicijalnog tumora, metakrona kada nastaje nakon više od 6 mjeseci od dijagnosticiranja prvog tumora ili simultana kada nastaju paralelno s inicijalnim tumorom. Smatra se da je rizik nastanka sinkronih i metakronih tumora veći kod pacijenata u ranim stadijima tumorske bolesti zbog njihovog boljeg preživljenja u odnosu na pacijente s uznapredovalim tumorima [1][2][3][4][5][6] . Također se smatra da je veći rizik od javljanja drugog primarnog tumora kod ljudi mlađih od šezdeset godina te da raste 3 % na godinu kod pacijenata koji prežive neki od karcinoma glave i vrata [3][4][5][6] .…”

“…Genetska preosjetljivost, imunodeficijencija kao i mogući učinak liječenja primarnog tumora prvenstveno radiokemoterapijom također može imati utjecaj na promjenu sluzničkog epitela kao preduvjet nastanka polja kancerizacije [8][9][10][11][12][13] . Organski sustavi u kojima se može naći ovaj fenomen osim aerodigestivnog trakta su i genitalni, probavni kao i koža [1][2][3][4][5] . S obzirom na lokalizaciju karcinoma na larinksu smatra se da je kod supraglotičnih karcinoma češći drugi primarni tumor nego kod glotičnog karcinoma.…”

Risk of second primary malignancy in patients with sinonasal tumors: a population‐based cohort study

“…Their analysis found that patients diagnosed with head and neck cancer had a 36% cumulative risk of developing an additional malignancy within 20 years . Subsequent studies have confirmed the increased risk of SPM in these patients, and have demonstrated that a second malignancy significantly diminishes long‐term prognosis . These findings highlight the importance of assessing for additional malignancy and identifying risk factors in order to maximize patient outcomes.…”