Rigid Triple Endoscopy Improves Clinical Staging of Primary Head and Neck Cancer

Abstract

Background: Correct pre-therapeutic staging of the first primary carcinoma (FPC) and detection of simultaneous second primary carcinomas (SSPCs) decisively influence therapy and prognosis of head and neck squamous cell carcinomas (HNSCC). The aim of this study was to determine the benefit of pre-therapeutic triple endoscopy for detection of SSPC and pre-therapeutic T category. Methods: A cohort of 234 HNSCC patients with completed triple endoscopy was reviewed, focusing on pre-therapeutic T category and SSPC. Risk stratification for different subsites was evaluated. Results: The risk for SSPC was 5.56%. FPC of the oral cavity and oropharynx had the highest prevalence of SSPC (46.15%, 38.46%); most SSPCs were found in the hypopharynx. No SSPCs were found in the oral cavity, nasopharynx and oesophagus. Significant results in correct pre-therapeutic T staging have been achieved for the larynx (p = 0.021) and the oropharynx (p = 0.001). Conclusions: Triple endoscopies seem to be inadequate for SSPC detection in HNSCC patients. Endoscopies of the trachea and oesophagus should be reconsidered. Alternatively, risk-directed endoscopies of the hypopharynx might be performed in patients with oral cancer. For evaluation of resectability, conducting triple endoscopy could be reduced to a single endoscopy because the complication rate is low and pre-therapeutic T staging can be improved.

Second primary tumors in head and neck cancer patients: The importance of a “tailored” surveillance

“…After the first 5 years, the patient continues follow‐up once per year with a clinical visit, regardless of subsite cancer and stage at diagnosis or treatments received. Several studies evaluated the role of triple endoscopy in this setting, especially in pre‐treated work‐up to diagnosticate the synchronous SPT (Krishnatreya et al., 2015; Priante et al., 2014; Sharma et al., 2018). However, most reports only describe the frequency of diagnoses and not the benefit on survival of these patients (Priante et al., 2011).…”

The Utility of Gastrointestinal Endoscopic Examination Versus Positron Emission Tomography–Computed Tomography in the Detection of Second Primary Lesions in Korean Patients With Head and Neck Cancer

“…Wang 15 Sharma et al demonstrated that SSPL prevalence was 5.56% (13 SSPL/234 HNSCC) and only 3 (23.13%) of 13 of SSPLs were exclusively found by triple endoscopy (direct laryngoscopy, bronchoscopy, and esophagoscopy). 16 However, other authors believed that endoscopic screening has a low yield and do not recommend it for concurrent use with other imaging modalities. 10,17 Additionally, some studies suggested that the incidences of SSPL in HNSCC were low.…”

Update: Epidemiologie und Prävention des Oropharynxkarzinoms

“…Die Änderungen wurden also maßgeblich unter dem Aspekt der rein prognostischen Bedeutung für das Überleben der Patienten durchgeführt. Man muss also bei der Betrachtung von Tumorstadien sehr darauf achten, insbesondere bei paralleler Tabak-, Alkohol-und HPV-Assoziation, nicht in die Gefahr des "Undertreatments", einer unangemessen reduzierten Therapieintensität, zu geraten [61,62,63].…”