Strahlentherapie und Onkologie

, Volume 189, Issue 10, pp 874–880 | Cite as

Second primary malignancies in head and neck cancer patients

High prevalence of curable-stage disease
  • H.A. WolffEmail author
  • C.R.M. Wolff
  • C.F. Hess
  • K. Jung
  • S. Sennhenn-Kirchner
  • M. Hinterthaner
  • A. Müller-Dornieden
  • W. Körber
  • K. Marten-Engelke
  • R. Roedel
  • H. Christiansen
  • C. Engelke
Original article


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.


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.


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


Carcinoma, squamous cell of head and neck Neoplasms, second primary Low-dose CT Radiochemotherapy Screening 

Bösartige Zweittumore bei Patienten mit Kopf-Hals-Tumoren

Hohe Prävalenz kurativer Erkrankungsstadien


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.


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.


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.


Plattenepithelkarzinom im Kopf-Hals-Bereich Zweittumor Low-dose CT Strahlenchemotherapie Screening 



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.


  1. 1.
    Aberle DR, Adams AM, Berg CD et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409PubMedCrossRefGoogle Scholar
  2. 2.
    Bradley PJ, Bradley PT (2010) Searching for metachronous tumours in patients with head and neck cancer: the ideal protocol! Curr Opin Otolaryngol Head Neck Surg 18:124–133PubMedCrossRefGoogle Scholar
  3. 3.
    Chin D, Boyle GM, Porceddu S et al (2006) Head and neck cancer: past, present and future. Expert Rev Anticancer Ther 6:1111–1118PubMedCrossRefGoogle Scholar
  4. 4.
    Christiansen H, Hermann RM, Martin A et al (2006) Long-term follow-up after transoral laser microsurgery and adjuvant radiotherapy for advanced recurrent squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 65:1067–1074PubMedCrossRefGoogle Scholar
  5. 5.
    Corvo R (2007) Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol 85:156–170PubMedCrossRefGoogle Scholar
  6. 6.
    Deantonio L, Masini L, Brambilla M et al (2013) Dysphagia after definitive radiotherapy for head and neck cancer: correlation of dose–volume parameters of the pharyngeal constrictor muscles. Strahlenther Onkol 189:230–236PubMedCrossRefGoogle Scholar
  7. 7.
    Gao Y, Hu N, Han XY et al (2011) Risk factors for esophageal and gastric cancers in Shanxi Province, China: a case–control study. Cancer Epidemiol 35:e91–e99PubMedCrossRefGoogle Scholar
  8. 8.
    Henschke CI, McCauley DI, Yankelevitz DF et al (2001) Early lung cancer action project: a summary of the findings on baseline screening. Oncologist 6:147–152PubMedCrossRefGoogle Scholar
  9. 9.
    Hernandez-Boluda JC, Pereira A, Cervantes F et al (2012) A polymorphism in the XPD gene predisposes to leukemic transformation and new nonmyeloid malignancies in essential thrombocythemia and polycythemia vera. Blood 119:5221–5228PubMedCrossRefGoogle Scholar
  10. 10.
    Hess CF, Kortmann RD, Schmidberger H, Bamberg M (1994) How relevant is secondary leukaemia for initial treatment selection in Hodgkin’s disease? Eur J Cancer 30A:1441–1447PubMedCrossRefGoogle Scholar
  11. 11.
    Kazi R, Manikanthan K, Pathak KA, Dwivedi RC (2010) Head and neck squamous cell cancers: need for an organised time-bound surveillance plan. Eur Arch Otorhinolaryngol 267:1969–1971PubMedCrossRefGoogle Scholar
  12. 12.
    Koshy M, Rich SE, Mahmood U, Kwok Y (2012) Declining use of radiotherapy in stage I and II Hodgkin’s disease and its effect on survival and secondary malignancies. Int J Radiat Oncol Biol Phys 82:619–625PubMedCrossRefGoogle Scholar
  13. 13.
    Lee KD, Lu CH, Chen PT et al (2009) The incidence and risk of developing a second primary esophageal cancer in patients with oral and pharyngeal carcinoma: a population-based study in Taiwan over a 25 year period. BMC Cancer 9:373PubMedCrossRefGoogle Scholar
  14. 14.
    Leon X, Quer M, Diez S et al (1999) Second neoplasm in patients with head and neck cancer. Head Neck 21:204–210PubMedCrossRefGoogle Scholar
  15. 15.
    MacMahon H, Austin JH, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237:395–400PubMedCrossRefGoogle Scholar
  16. 16.
    Olthoff A, Ewen A, Wolff HA et al (2009) Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer. Strahlenther Onkol 185:303–309PubMedCrossRefGoogle Scholar
  17. 17.
    Pelucchi C, Tramacere I, Boffetta P et al (2011) Alcohol consumption and cancer risk. Nutr Cancer 63:983–990PubMedCrossRefGoogle Scholar
  18. 18.
    Petit T, Georges C, Jung GM et al (2001) Systematic esophageal endoscopy screening in patients previously treated for head and neck squamous-cell carcinoma. Ann Oncol 12:643–646PubMedCrossRefGoogle Scholar
  19. 19.
    Rades D, Meyners T, Kazic N et al (2011) Comparison of radiochemotherapy alone to surgery plus radio(chemo)therapy for non-metastatic stage III/IV squamous cell carcinoma of the head and neck: a matched-pair analysis. Strahlenther Onkol 187:541–547PubMedCrossRefGoogle Scholar
  20. 20.
    Rades D, Ulbricht T, Hakim SG, Schild SE (2012) Cisplatin superior to carboplatin in adjuvant radiochemotherapy for locally advanced cancers of the oropharynx and oral cavity. Strahlenther Onkol 188:42–48PubMedCrossRefGoogle Scholar
  21. 21.
    Rodel RM, Steiner W, Muller RM et al (2009) Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure. Head Neck 31:583–592PubMedCrossRefGoogle Scholar
  22. 22.
    Sciubba JJ (2001) Oral cancer. The importance of early diagnosis and treatment. Am J Clin Dermatol 2:239–251PubMedCrossRefGoogle Scholar
  23. 23.
    Simon C, Plinkert PK (2008) Combined modality approaches in the treatment of head and neck cancer patients. HNO 56:575–584PubMedCrossRefGoogle Scholar
  24. 24.
    Swensen SJ, Jett JR, Sloan JA et al (2002) Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med 165:508–513PubMedCrossRefGoogle Scholar
  25. 25.
    Tribius S, Sommer J, Prosch C et al (2013) Xerostomia after radiotherapy: what matters—mean total dose or dose to each parotid gland? Strahlenther Onkol 189:216–222PubMedCrossRefGoogle Scholar
  26. 26.
    Tsou YA, Hua CH, Tseng HC et al (2007) Survival study and treatment strategy for second primary malignancies in patients with head and neck squamous cell carcinoma and nasopharyngeal carcinoma. Acta Otolaryngol 127:651–657PubMedCrossRefGoogle Scholar
  27. 27.
    Weiderpass E (2010) Lifestyle and cancer risk. J Prev Med Public Health 43:459–471PubMedCrossRefGoogle Scholar
  28. 28.
    Wolff HA, Bosch J, Jung K et al (2010) High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer. Strahlenther Onkol 186:262–268PubMedCrossRefGoogle Scholar
  29. 29.
    Wolff HA, Overbeck T, Roedel RM et al (2009) Toxicity of daily low dose cisplatin in radiochemotherapy for locally advanced head and neck cancer. J Cancer Res Clin Oncol 135:961–967PubMedCrossRefGoogle Scholar

Copyright information

© Springer Heidelberg Berlin 2013

Authors and Affiliations

  • H.A. Wolff
    • 1
    Email author
  • C.R.M. Wolff
    • 1
    • 10
  • C.F. Hess
    • 1
  • K. Jung
    • 2
  • S. Sennhenn-Kirchner
    • 3
  • M. Hinterthaner
    • 4
  • A. Müller-Dornieden
    • 5
  • W. Körber
    • 6
  • K. Marten-Engelke
    • 7
  • R. Roedel
    • 8
  • H. Christiansen
    • 1
    • 9
  • C. Engelke
    • 7
  1. 1.Department of Radiotherapy and RadiooncologyUniversitätsmedizin GöttingenGöttingenGermany
  2. 2.Department of Medical StatisticsUniversitätsmedizin GöttingenGöttingenGermany
  3. 3.Department of Oral and Maxillofacial SurgeryUniversitätsmedizin GöttingenGöttingenGermany
  4. 4.Department of Thoracic and Cardiovascular SurgeryUniversitätsmedizin GöttingenGöttingenGermany
  5. 5.Department of General SurgeryUniversitätsmedizin GöttingenGöttingenGermany
  6. 6.Department of PneumologyEvangelisches Krankenhaus WeendeBovenden-LenglernGermany
  7. 7.Department of Diagnostic RadiologyUniversitätsmedizin GöttingenGöttingenGermany
  8. 8.Department of OtorhinolaryngologyUniversitätsmedizin GöttingenGöttingenGermany
  9. 9.Department of Radiotherapy and RadiooncologyMedizinische Hochschule HannoverHannoverGermany
  10. 10.Department of Dermatology, Venereology and AllergologyUniversitätsmedizin GöttingenGöttingenGermany

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