Treatment of Squamous Cell Carcinoma of the Esophagus Synchronously Associated with Head and Neck Cancer

Abstract

Abstract. Background/Aim: The aim of this study was to clarify the treatment strategy for synchronous squamous cell carcinoma of the esophagus (ESCC) and head and neck cancer (HNC). Patients and MethodsThe multifocal development of squamous cell carcinoma (SCC) is frequently observed in the upper aerodigestive tract (UADT) including the head and neck region and the esophagus. The association of these cancers is observed both synchronously and metachronously (1). These cancers are highly aggressive and until relatively recently were usually associated with a dismal prognosis. Environmental factors such as cigarette smoking and alcohol drinking are closely related to the development of SCC of the UADT. Furthermore, we have reported that both heavy smoking and heavy drinking have synergistic effects on multi-centric carcinogenesis of the UADT (1, 2).Regarding the treatment strategy, surgical resection has been the gold standard of treatment for localized UADT cancer. However, this surgery is extremely invasive and is also associated with high rates of mortality and morbidity, especially in patients with esophageal cancer and pharyngeal cancer (3, 4). Patients with synchronous squamous cell carcinoma of the esophagus (ESCC) and head and neck cancer (HNC) often require for extremely complex and invasive surgical procedures in order to resect both lesions (5-7). The surgical procedures for synchronous double cancer therefore represent an important clinical problem.On the other hand, squamous cell carcinoma of the UADT is relatively sensitive to radiation and anticancer drugs such as 5-fluorouracil, cisplatin and paclitaxel (8-10). Definitive chemoradiotherapy is frequently indicated for ESCC while invasive esophagectomy is normally avoided (11). For patients with HNC, the preservation of the vocal function can be achieved if HNC is cured after definitive chemoradiotherapy (CRT). Definitive CRT for synchronous ESCC and HNC is controversial due to the larger radiation field and associated toxicity (12). In our institute, simultaneous definitive CRT has been applied in the treatment of synchronous ESCC and HNC (13,14). Another problem is that salvage treatment, which is frequently troublesome, may be indicated in cases with either residual or recurrent cancer after definitive CRT (4,11).In this study, we reviewed the clinical characteristics and treatment outcomes in 91 patients with synchronous ESCC and HNC, and paid special attention to simultaneous surgical resection and simultaneous CRT for both cancers. 909