Synchronous second primary tumors in 2,016 head and neck cancer patients: Role of symptom-directed panendoscopy

Authors

  • Erlend Rennemo MD,

    Corresponding author
    1. Department of Otolaryngology/Head and Neck Surgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway
    • Oslo Universitetssykehus–Rikshospitalet, Postboks 4953 Nydalen, N-0424 Oslo, Norway
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  • Ulf Zätterström MD, PhD,

    1. Department of Otolaryngology/Head and Neck Surgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway
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  • Morten Boysen MD, PhD

    1. Department of Otolaryngology/Head and Neck Surgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway
    2. The Medical Faculty, University of Oslo, Oslo, Norway
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Second primary tumors (SPTs) are prevalent in head and neck cancer patients. Synchronous SPTs occur within the first 6 months after diagnosis of a first primary tumor. Work-up of first primary head and neck cancers may include panendoscopy if SPTs are suspected. It is unclear whether this strategy has significant impact on treatment results.

Study Design:

Prospectively recorded data on head and neck cancer patients treated at an academic tertiary referral center.

Methods:

The distribution of SPTs was retrieved from a database of 2,016 patients with head and neck cancer. Initial work-up included panendoscopy when an SPT was clinically suspected.

Results:

Of 2,016 patients, 49 (2.4%) had synchronous SPTs. Of these, there were 26 diagnosed simultaneously with the first primary tumor, of which 18 (69%) were located in areas covered by panendoscopy. The remaining 23 were nonsimultaneous synchronous SPTs; 10 of them were located at sites accessible by panendoscopy, of which 6 were in the bronchial tree. Median survival after simultaneous SPTs was 9 months versus 3 months after nonsimultaneous synchronous SPTs (P = not significant). The highest frequency of synchronous SPTs was seen with first primary tumors of the hard palate, the dorsum of the tongue, and of the mandibular gingiva.

Conclusions:

Symptom-directed panendoscopy at initial work-up was successful at finding SPTs of the upper aerodigestive tract, but not SPTs located in the lower airways. Synchronous SPTs missed at initial work-up did not have significantly worse prognosis than simultaneous SPTs. Laryngoscope, 2011

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