Risk of second primary cancer among patients with head and neck cancers: A pooled analysis of 13 cancer registries

Abstract

The objective of the study was to assess the risk of second primary cancers (SPCs) following a primary head and neck cancer (oral cavity, pharynx and larynx) and the risk of head and neck cancer as a SPC. The present investigation is a multicenter study from 13 population-based cancer registries. The study population involved 99,257 patients with a first primary head and neck cancer and contributed 489,855 person-years of follow-up. To assess the excess risk of SPCs following head and neck cancers, we calculated standardized incidence ratios (SIRs) by dividing the observed numbers of SPCs by the expected number of cancers calculated from accumulated person-years and the age-, sex-and calendar period-specific first primary cancer incidence rates in each of the cancer registries. During the observation period, there were 10,826 cases of SPCs after head and neck cancer. For all cancer sites combined, the SIR of SPCs was 1.86 (95% CI = 1.83-1.90) and the 20-year cumulative risk was 36%. Lung cancer contributed to the highest proportion of the SPCs with a 20-year cumulative risk of 13%. Excess second head and neck cancer risk was observed 10 years after diagnosis with lymphohaematopoietic cancers. The most common SPC following a first primary head and neck cancer was lung cancer. However, the highest excess of SPCs was in the head and neck region. These patterns were consistent with the notion that the pattern of cancer in survivors of head and neck cancer is dominated by the effect of tobacco smoking and alcohol drinking. ' 2008 Wiley-Liss, Inc.Key words: head and neck cancer; second cancer A significant improvement in locoregional control of head and neck squamous cell carcinoma has been seen over the last decades, due to the introduction of new surgical techniques, improved radiotherapy techniques and the use of chemotherapy. However, 5-year relative survival from head and neck cancer has not increased greatly over the period of 1985-1994. 1,2 One of the reasons for the lack of improvement in overall survival is the frequent development of second primary cancers (SPCs) that occur more often in head and neck cancer patients than in patients with cancers of other sites 3 and lead to poor prognosis. [4][5][6] Head and neck cancers (oral cavity, pharynx and larynx) comprise around 5% of all cancer cases worldwide and result in 6% of cancer deaths in men and 3% in women.7 SPCs after head and neck cancers are mostly found in the aerodigestive tract, including the lung and esophagus, which leads to a significant decrease in survival. 5 In contrast to the overall 5-year survival rate for head and neck cancer patients of approximately 50%, the 5-year survival rate in head and neck cancer patients who developed SPC was around 20% after the SPC was diagnosed. 4,5 The 5-year survival rates after SPC diagnosis were above 30% if the SPC was also a head and neck cancer and decreased to 8% if the SPC was outside the head and neck area.

Second primary esophageal or lung cancer in patients with head and neck carcinoma in Taiwan: incidence and risk in relation to primary index tumor site

“…The risk excess of second esophageal cancer is always higher than that of second lung cancer, regardless of the index tumor site, follow-up interval and age at diagnosis. Similar observations were reported by other authors, who analyzed 99,257 HNC patients from a pooled dataset of 13 cancer registries (Chuang et al 2008). For this reason, periodic panendoscopy is advocated for screening.…”

Re-irradiation with cetuximab or cisplatin-based chemotherapy for recurrent squamous cell carcinoma of the head and neck

“…Nevertheless, locoregional recurrence remains the main pattern of failure for initially successfully treated patients [3,5]. Furthermore, this group of patients is at an increased risk of secondary malignancies, with an incidence of at least 3 % de novo SCCHN per year [6][7][8]. Salvage surgery remains the primary curative option for treating patients with recurrent or de novo SCCHN originating in a previously irradiated area.…”

Second Primary Tumors in Patients with Head and Neck Cancer

“…The incidence of SPT varies across several studies, depending mainly on the follow-up time and systematic screening of the cases [9][10][11][12][13][14]15•, [16][17][18]. In three large series of cases, Chuang et al [15•] with 99,257 patients, Haughey et al [11] with 40,287, and Panosetti et al [9] with 9089, the SPT incidence was 10.9%, 14.2%, and 9.4%, respectively.…”