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.
References
Aberle DR, Adams AM, Berg CD et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409
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 18:124–133
Chin D, Boyle GM, Porceddu S et al (2006) Head and neck cancer: past, present and future. Expert Rev Anticancer Ther 6:1111–1118
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 65:1067–1074
Corvo R (2007) Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother Oncol 85:156–170
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 189:230–236
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–e99
Henschke CI, McCauley DI, Yankelevitz DF et al (2001) Early lung cancer action project: a summary of the findings on baseline screening. Oncologist 6:147–152
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 119:5221–5228
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:1441–1447
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 267:1969–1971
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 82:619–625
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 9:373
Leon X, Quer M, Diez S et al (1999) Second neoplasm in patients with head and neck cancer. Head Neck 21:204–210
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 237:395–400
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 185:303–309
Pelucchi C, Tramacere I, Boffetta P et al (2011) Alcohol consumption and cancer risk. Nutr Cancer 63:983–990
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 12:643–646
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 187:541–547
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 188:42–48
Rodel RM, Steiner W, Muller RM et al (2009) Endoscopic laser surgery of early glottic cancer: involvement of the anterior commissure. Head Neck 31:583–592
Sciubba JJ (2001) Oral cancer. The importance of early diagnosis and treatment. Am J Clin Dermatol 2:239–251
Simon C, Plinkert PK (2008) Combined modality approaches in the treatment of head and neck cancer patients. HNO 56:575–584
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 165:508–513
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 189:216–222
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 127:651–657
Weiderpass E (2010) Lifestyle and cancer risk. J Prev Med Public Health 43:459–471
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 186:262–268
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 135:961–967
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This manuscript was edited by the “American Journal Experts” editorial service.
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On behalf of all authors, the corresponding author states that there are no conflicts of interest.
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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
Keywords
- Carcinoma, squamous cell of head and neck
- Neoplasms, second primary
- Low-dose CT
- Radiochemotherapy
- Screening