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

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.