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Second primary malignancies in head and neck cancer patients

High prevalence of curable-stage disease

Bösartige Zweittumore bei Patienten mit Kopf-Hals-Tumoren

Hohe Prävalenz kurativer Erkrankungsstadien

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Abstract

Background and purpose

Patients treated for squamous cell carcinoma of the head and neck (HNSCC) carry a high risk of second primary malignancies (SPM). Recently, computed tomography (CT) of the chest was shown to significantly decrease the risk of death due to bronchial carcinoma (BC) in a cohort of smokers whose risk of BC is increased but might be lower than that of patients previously treated for HNSCC. Thus, the present study evaluated the potential benefit of CT and other examinations in the detection of SPM in HNSCC patients.

Patients and methods

Between July 2008 and November 2011, 118 participants underwent a prospective, systematic examination for SPM (13 women, 105 men, median age 62 years). All patients had been previously treated for HNSCC and showed no recurrence or distant metastases at the time of the study start. CT scans, ear–nose–throat endoscopy, and endoscopy of the esophagus and stomach were performed.

Results

Overall, 33 suspicious findings were clarified by additional investigations. In all, 26 SPM were confirmed in 21 of 118 patients (18 %; 10 lung, 7 HNSCC, 3 gastrointestinal, 1 renal). Eighteen of these 21 patients (86 %) underwent therapy with curative intent.

Conclusion

The examinations revealed a high prevalence of curable stage SPM in HNSCC patients. Adapting a surveillance scheme including a chest CT is recommended.

Zusammenfassung

Hintergrund und Ziel

Patienten, welche bereits aufgrund eines Plattenepithelkarzinoms im Kopf-Hals-Bereich (HNSCC) behandelt wurden, weisen ein hohes Risiko für bösartige Zweittumore („second primary malignancies“, SPM) auf. In diesem Zusammenhang führte eine Computertomographie (CT) der Lunge in einer kürzlich veröffentlichten Studie bei Rauchern, welche bekanntlich ein erhöhtes Risiko für Bronchialkarzinome (BC) tragen, zu einer signifikanten Reduktion der Mortalität durch eben diese Tumore. Möglicherwiese ist das Risiko von HNSCC-Patienten, ein BC zu entwickeln, im Vergleich aber sogar höher. Aus diesem Grund evaluiert die vorliegende Studie einen möglichen Benefit einer CT und anderer Untersuchungen zur Feststellung eines Zweittumors bei HNSCC-Patienten.

Patienten und Methoden

Zwischen Juli 2008 und November 2011 unterzogen sich 118 Studienteilnehmer prospektiv einer systematischen Untersuchung auf einen Zweittumor (13 Frauen, 105 Männer, medianes Alter 62 Jahre). Alle Patienten wurden zuvor aufgrund eines HNSCC behandelt und entwickelten bisher kein Lokalrezidiv oder Fernmetastasen. Bei allen Patienten wurden eine CT der Lunge, eine Panendoskopie des Hals-Nasen-Rachen-Bereichs und eine Endoskopie des Ösophagus und Magens durchgeführt.

Ergebnisse

Insgesamt wurden 33 auffällige Befunde durch weitere Untersuchungen abgeklärt. Hierbei wurden bei 21 von 118 Patienten (18 %) 26 bösartige Tumore bestätigt (10 BC, 7 HNSCC, 3 ösophagogastrale Tumore und 1 Nierentumor). Insgesamt 18 dieser 21 Patienten (86 %) konnten erneut kurativ behandelt werden.

Schlussfolgerung

Die vorliegenden Ergebnisse zeigen eine hohe Prävalenz an asymptomatischen, kurativ behandelbaren Zweittumoren bei HNSCC-Patienten. Eine Ergänzung der Routinenachsorge durch eine Thorax-Computertomographie wird empfohlen.

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Acknowledgments

This manuscript was edited by the “American Journal Experts” editorial service.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiotherapy and Radiooncology, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    H.A. Wolff M.D., C.R.M. Wolff M.D., C.F. Hess M.D., Ph.D. & H. Christiansen M.D.

  2. Department of Medical Statistics, Universitätsmedizin Göttingen, Göttingen, Germany

    K. Jung Ph.D.

  3. Department of Oral and Maxillofacial Surgery, Universitätsmedizin Göttingen, Göttingen, Germany

    S. Sennhenn-Kirchner M.D.

  4. Department of Thoracic and Cardiovascular Surgery, Universitätsmedizin Göttingen, Göttingen, Germany

    M. Hinterthaner M.D.

  5. Department of General Surgery, Universitätsmedizin Göttingen, Göttingen, Germany

    A. Müller-Dornieden M.D.

  6. Department of Pneumology, Evangelisches Krankenhaus Weende, Bovenden-Lenglern, Germany

    W. Körber M.D.

  7. Department of Diagnostic Radiology, Universitätsmedizin Göttingen, Göttingen, Germany

    K. Marten-Engelke M.D. & C. Engelke M.D.

  8. Department of Otorhinolaryngology, Universitätsmedizin Göttingen, Göttingen, Germany

    R. Roedel M.D.

  9. Department of Radiotherapy and Radiooncology, Medizinische Hochschule Hannover, Hannover, Germany

    H. Christiansen M.D.

  10. Department of Dermatology, Venereology and Allergology, Universitätsmedizin Göttingen, Göttingen, Germany

    C.R.M. Wolff M.D.

Authors
  1. H.A. Wolff M.D.
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  2. C.R.M. Wolff M.D.
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  3. C.F. Hess M.D., Ph.D.
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  4. K. Jung Ph.D.
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  5. S. Sennhenn-Kirchner M.D.
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  6. M. Hinterthaner M.D.
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  7. A. Müller-Dornieden M.D.
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  8. W. Körber M.D.
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  9. K. Marten-Engelke M.D.
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  10. R. Roedel M.D.
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  11. H. Christiansen M.D.
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  12. C. Engelke M.D.
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Corresponding author

Correspondence to H.A. Wolff M.D..

Additional information

Hendrik A Wolff and Cornelia RM Wolff share first authorship.Christoph Engelke and Hans Christiansen share senior authorship.

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Wolff, H., Wolff, C., Hess, C. et al. Second primary malignancies in head and neck cancer patients. Strahlenther Onkol 189, 874–880 (2013). https://doi.org/10.1007/s00066-013-0404-4

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  • DOI: https://doi.org/10.1007/s00066-013-0404-4

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