Second primary lung malignancy in head and neck cancer patients

Head and neck cancer with synchronous nodules of the lung as a diagnostic and therapeutic challenge - A systematic review

Head and neck squamous cell carcinoma (HNSCC) often presents with synchronous nodules of the lung (sNL), which may be benign nodules, second primary malignancies or metastases of HNSCC. We sought to gain an insight into the incidence of sNL and synchronous second primary of the lung (sSPML) in HNSCC patients and current opinions on useful diagnostic and therapeutic approaches. We conducted a systematic search of the PubMed database for articles that reported the simultaneous detection of HNSCC and sNL/sPML, within the timeframe of diagnosis and staging. Only studies involving humans were included, without restrictions for sex, age, ethnicity, or smoking history. All articles were categorised according to the Oxford Centre of Evidence-Based Medicine levels and their data collected. Data from 24 studies were analysed. Amongst HNSCC, the mean overall incidence rate of sNL and sSPML was 11.4% (range: 1.3-27%) and 2.95% (range: 0.4-7.4%), respectively. The possibility of a sNL to be a sSPML cannot be ignored (mean: 35.2%). Studies investigating smoking habits showed that the majority (98-100%) of HNSCC patients with sSPML were previous or active smokers. Detection of human papillomavirus through DNA analysis, p16 immunohistochemistry, and identification of clonal evolution were useful in differentiating metastasis from sSPML. 18FDG-PET scan was the most reliable method to diagnose sSPML (sensitivity: 95%; specificity: 96%; positive predictive value: 80%). With early sSPML detection and curative treatment, the 5-year overall survival rate is 34-47%. However, the proposed advantage of early detection warrants further evidence-based justification.

Impact of primary site on survival in patients with nasopharyngeal carcinoma from 2004 to 2015

Background

Nasopharynx carcinoma (NPC) is the most common malignant tumor of the nasopharynx. Many studies have shown some factors related with the prognosis of NPC patients. Our study aims to evaluate the differences of prognosis between initial and second primary NPC.

Material and methods

The Surveillance, Epidemiology, and End Results (SEER) program was used to perform the population-based analysis in NPC patients who were newly diagnosed between 2004 and 2015. Kaplan-Meier and Cox regressions were used to evaluate the effects of primary site on the overall survival (OS), as well as the cancer-specific survival (CSS).

Results

Our study included 5,012 NPC patients: 4,474 initial primary NPC patients and 5,38 s primary NPC patients. Significant differences were observed in sex, age at diagnosis, race, median household income, histological type, American Joint Committee on Cancer (AJCC) stage, N-stage, radiation treatment and chemotherapy between patients with initial and second NPC (P < 0.05). Moreover, the patients with second NPC had longer survival months. In addition, radiation and chemotherapy were recommended both in first and second primary NPC patients.

Conclusion

Worse prognosis was observed in patients with second primary NPC compared with those with primary NPC in all subgroups of AJCC stage and age at diagnosis.

Clinical characteristics and prognosis of patients with hypopharyngeal cancers with multiple primary cancers: A propensity score matched analysis

PURPOSE

This study aimed to identify the clinical characteristics of hypopharyngeal squamous cell carcinoma (HPSCC) patients with multiple primary cancers (MPCs) and to compare differences between patients with metachronous and synchronous MPCs.

MATERIAL AND METHODS

This study included 219 patients with HPSCC treated at our center between 2008 and 2020; the clinical characteristics and prognosis of 66 patients with MPCs were analyzed. Propensity score matching (PSM) was used to balance the factors between patients with synchronous and metachronous MPCs.

RESULTS

Sixty-six patients with HPSCC (66/219, 30.1%) experienced MPCs, of which 29 were synchronous and 37 were metachronous. The esophagus (n = 39, 59.1%), lung (n = 10, 15.2%), and oropharynx (n = 4, 6.1%) were the three most common sites of MPCs in both the synchronous and metachronous groups. More patients with synchronous MPCs were stage T1-2 (82.8% vs. 59.5%, P = 0.041) compared to those with metachronous MPCs. Among the 24 pairs of patients after PSM, patients with metachronous MPCs had higher 3-year progression-free survival (PFS) (52.5% vs. 16.3%, P < 0.001) and overall survival (OS) (58.5% vs. 22.1%, P = 0.001) than those with synchronous cancers. Multivariate Cox analysis showed that patients with synchronous MPCs had shorter PFS (HR 4.45, 95% CI 1.819-10.885, P = 0.001) and OS (HR 3.918, 95% CI 1.591-9.645, P = 0.003).

CONCLUSION

MPCs are common among patients with HPSCC, and patients with metachronous MPCs had better survival than those with synchronous MPCs. Clinicians should be aware of the possibility of MPCs in patients with HPSCC and optimize treatment to improve outcomes.

Indicators for secondary carcinoma in head and neck cancer patients following curative therapy: A retrospective clinical study

Patients with head and neck squamous cell carcinoma (HNSCC) are at risk for local and regional relapse, as well as for occurrence of synchronous or metachronous secondary carcinoma. The aim of this retrospective study was to evaluate the frequency of secondary malignancies amongst HNSCC patients and their association with age, sex and TNM classification, as well as smoking and alcohol abuse. Data from 394 patients with HNSCC who were treated at the Department of Otorhinolaryngology-Head and Neck Surgery of the University Hospital Mannheim between 2011 and 2015 were retrieved and analyzed using t-tests and P≤0.05 was considered statistically significant. Of the 394 patients, 50 (12.7%) developed a secondary carcinoma. In this cohort, >70% of secondary malignancies were diagnosed using clinical inspection or microlaryngoscopy. The majority of secondary malignancies were identified in the oropharynx, with men being more often affected overall. Continued abuse of carcinogenic substances appeared to increase the incidence of secondary carcinoma, whereas the localization of the primary tumor, age, sex or TNM classification were not identified as significant indicators of the occurrence of a secondary carcinoma. The purpose of the present study was to emphasize the importance of intensive follow-up to ensure early detection of secondary malignancies. The aim was to help predict numbers and occurrence within smaller cohorts, and to evaluate the quality of data collected during the establishment of a certified tumor center. To fully evaluate the role of continued exposure to noxious substances and other possible contributing factors, and in order to improve the rate of early diagnosis and establish preventive strategies, multicentered studies with larger cohorts are required.

Outcomes and toxicities following stereotactic ablative radiotherapy for pulmonary metastases in patients with primary head and neck cancer

BACKGROUND

Metastatic head and neck cancers (HNCs) predominantly affect the lungs and have a two-year overall survival (OS) of 15% to 50%, if amenable for pulmonary metastasectomy.

METHODS

Retrospective review of the two-year local control (LC), local-regional control (LRC) within the same lobe, OS, and toxicity rates in consecutive patients with metastatic pulmonary HNC who underwent stereotactic ablative radiotherapy (SABR) January 2007 to May 2018.

RESULTS

Evaluated 82 patients with 107 lung lesions, most commonly squamous cell carcinoma (SCC; 64%). Median follow-up was 20 months (range: 9.0-97.6). Systemic therapy administered in 34%. LC, LRC, and OS rates were 94%, 90%, and 62%. Patients with oligometastatic disease had a higher OS than polymetastatic disease, 72% vs 44% (HR = 0.30, 95% CI: 0.14-0.64; P = .008). OS in oligometastatic non-SCC and SCC were 100% and 66% (P = .03). There were no grade ≥3 toxicities.

CONCLUSIONS

Metastatic pulmonary HNCs after SABR have a two-year OS rate comparable to pulmonary metastasectomy.

Second primary lung cancer following laryngeal cancer: retrospective study of incidence and multivariate analysis of risk factors in 209 patients

OBJECTIVE

To analyse the incidence of second primary lung cancer following treatment for laryngeal cancer and to identify risk factors for its development.

METHOD

Retrospective case series.

RESULTS

The five-year actuarial incidence of second primary lung cancer was 8 per cent (1.6 per cent per year). This was associated with a very poor median survival of seven months following diagnosis. Supraglottic tumours were associated with an increased risk of second primary lung cancer compared to glottic tumours in both univariate (hazard ratio = 4.32, p = 0.005) and multivariate analyses (hazard ratio = 4.14, p = 0.03).

CONCLUSION

Second primary lung cancer occurs at a rate of 1.6 per cent per year following a diagnosis of laryngeal cancer, and this is associated in a statistically significant manner with supraglottic primary tumour. The recent National Lung Cancer Screening Trial suggests a survival advantage of 20 per cent at five years with annual screening using low-dose computed tomography scanning of the chest in a comparable cohort to ours. These findings have the potential to inform post-treatment surveillance protocols in the future.

Survival of patients with head and neck cancer with metachronous multiple primary tumors is surprisingly favorable

Background

The objectives of this study are to determine the incidence and survival rate of patients with head and neck squamous cell carcinoma (HNSCC) with multiple primary tumors (MPT) in the HN‐region, lung, or esophagus.

Methods

Patient and tumor specific data of 1372 patients with HNSCC were collected from both the national cancer registry and patient records to ensure high‐quality double‐checked data.

Results

The total incidence of MPTs in the HN‐region, lung, and esophagus in patients with HNSCC was 11% (149/1372). Patients with lung MPTs and esophageal MPTs had a significant worse 5‐year survival than patients with HN‐MPTs (29%, 14%, and 67%, respectively, P < 0.001). The 5‐year survival rate for synchronous HN MPTs was only 25%, whereas it was surprisingly high for patients with metachronous HN MPT (85%, P < 0.001).

Conclusions

One of 10 patients with HNSCC develop MPTs in the HN‐region, lung, or esophagus. The 5‐year survival of patients with metachronous HN MPTs was surprisingly favorable.

Prognosis associated with synchronous or metachronous multiple primary malignancies in patients with completely resected non-small cell lung cancer

PURPOSE

To investigate the influence of multiple primary malignancies (MPMs) on the prognosis of patients with completely resected non-small cell lung cancer (NSCLC).

METHODS

The subjects of this retrospective study were 521 patients who underwent complete curative pulmonary resection for NSCLC. Patients were divided into two groups: those with and those without MPMs.

RESULTS

The 521 NSCLC patients included 184 patients (35.3%) with MPMs and 337 patients without MPMs. The overall 5-year survival rates for patients with vs those without MPMs were 66.1 and 75.6%, respectively (p = 0.0061). According to multivariate analysis, MPMs, age, gender, pathological stage, and interstitial pneumonia were independent predictors of prognosis. The 47 patients with synchronous MPMs and the 82 patients with metachronous MPMs found within the last 5 years had significantly poorer prognoses than patients without MPMs (p = 0.0048 and p = 0.0051, respectively). However, the prognoses of the 55 patients with metachronous MPMs that had been present for over 5 years did not differ from those of the patients without MPMs.

CONCLUSIONS

NSCLC patients with synchronous MPMs or metachronous MPMs diagnosed within the last 5 years had poor prognoses. Decisions about the best therapeutic strategies require comprehensive consideration of the organ location, malignant potential, recurrence, and prognosis of the MPMs. In contrast, decisions about the best therapeutic strategies for NSCLC patients with metachronous MPMs present for over 5 years should be based solely on the NSCLC.

Spindle cell carcinoma of the tongue combined with double primary cancer of the thyroid gland: a case report

Spindle cell carcinoma (SpCC) is referred to as a variant of oral squamous cell carcinoma. It is also known as "sarcomatoid squamous cell carcinoma" because it consists of normal squamous carcinoma cells with spindle-shaped cells that appear similar to a sarcoma. The term, "second primary tumor" (SPT) or "double primary tumor", is proposed for a second tumor that develops independently from the first. SPTs can present as either synchronous or metachronous lesions. Synchronous SPTs are defined as tumors occurring simultaneously or within 6 months after the first tumor. The patient in this case, whose primary tumor was in the tongue, was diagnosed with SpCC with metastases to both neck lymph nodes. This case also exhibited a second primary cancer as a synchronous lesion in the thyroid gland, which is uncommon. All carcinomas, both in the tongue and thyroid gland, were removed surgically, and especially in the tongue, an anterolateral thigh free flap was performed successfully to replace the defect.

Incidence of second primary malignancies in patients with treated head and neck cancer: a comprehensive review of literature

BACKGROUND

Increased incidence of a second primary aero-digestive malignancy after an index head and neck cancer (HNC) is well-documented. Furthermore, a clear set of surveillance strategies for second primary aero-digestive cancers in these patients exists.

METHODS

The goal of this article is to review the published literature on risk of second primary malignancies (SPMs) (including aero-digestive malignancies) after a treated index HNC as well as its associated predictors, prognosis and surveillance. Most relevant publications were identified through searching the PubMed database for articles published up to July 2012; epidemiologic evidence was synthesized and thoroughly analyzed.

FINDINGS

Data from randomized controlled trials, meta-analyses, population-based and cohort group studies, prior reviews, and case reports indicate an increased incidence of various SPMs after occurrence of a HNC. These cancers are not limited to upper aero-digestive sites. Common risk factors including environmental, genetic and immune factors may explain the increased incidence of second cancers in this patient population. In addition, site of the index HNC may predict the site of a future SPM.

CONCLUSIONS

As a general rule, oral cavity and oropharyngeal squamous cell cancers are associated more with head and neck region SPM, while laryngeal and hypopharyngeal cancers - with that of the lung. As these cancers confer dismal prognosis and shorter survival in patients with HNCs, several literature sources recommend close surveillance for and an aggressive therapy of SPM. Notwithstanding, their optimal management and follow-up schedule remains to be established.

Distinct features of second primary malignancies in head and neck cancer patients in Japan

Second primary malignancies (SPMs) are one of the most critical problems in treating head and neck cancer patients. Our hospital had 742 patients with a diagnosis of malignant head and neck tumors during the five-year period from 2002 to 2006. In this study, we analyzed 360 of those patients who were assumed to have risk factors such as alcohol and tobacco use: 106 oral, 120 laryngeal, 50 oropharyngeal and 84 hypopharyngeal cancer patients. Synchronous SPMs are defined as second cancers diagnosed at the same time or within 6 months of the diagnosis of the index head and neck cancers. There were 4 (3.8%) and 11 (10.4%) oral cancer patients, 11 (8.3%) and 8 (5.8%) laryngeal cancer patients, 7 (14.0%) and 4 (8.0%) oropharyngeal cancer patients, and 30 (28.6%) and 7 (8.3%) hypopharyngeal cancer patients with synchronous and metachronous SPMs, respectively. The number of metachronous patients with synchronous SPMs tended to increase during this time period. The frequencies of SPMs in oropharyngeal and hypopharyngeal cancer patients are similar to those in oral and laryngeal cancer patients. Notably, the most frequent SPMs are upper gastrointestinal tract cancers in Japan, compared to lung cancers in Europe. The five-year overall survival rate of patients with synchronous SPMs was significantly poorer than that of patients without any other tumor except for the index cancer, according to the Kaplan-Meier analysis. In conclusion, searching for SPMs in the upper gastrointestinal tract is a critical issue in head and neck cancer patients in Japan.