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Second Primary Tumors in Patients with Head and Neck Cancer

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Abstract

This is a review on second primary tumors in patients with head and neck cancer. These patients have a high risk of developing other cancers simultaneously or subsequently. The incidence of multiple primary tumors in this population can be as high as 27%. Recurrences are the most common cause of treatment failure within the first 2 years of follow-up. After the third year the diagnosis of a second primary tumor becomes the most important cause of morbimortality in head and neck cancer patients, especially in those treated for cancers early diagnosed. Most second primary tumors occur in the upper aerodigestive tract (40%–59%), lung (31%–37.5%), and esophagus (9%–44%). Patients who develop second primary tumor have a significant reduction of survival expectancy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Cancer Facts & Figures 2010 [online]. Atlanta: American Cancer Society; 2010 [cited 2010 Oct 3]. Available http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010.

  2. Mendenhall WM, Amdur RJ, Stringer SP, Villaret DB, Cassisi NJ. Radiation therapy for squamous cell carcinome of the tonsillar region: a preferred alternative to surgery? J Clin Oncol. 2000;18:2219–25.

    PubMed  CAS  Google Scholar 

  3. Cooney TR, Poulsen MG. Is routine follow-up useful after combined-modality therapy for advanced head and neck cancer? Arch Otolaryngol Head Neck Surg. 1999;125:379–82.

    PubMed  CAS  Google Scholar 

  4. Haas I, Hauser U, Ganzer U. The dilemma of follow-up in head and neck cancer patients. Eur Arch Otorhinolaryngol. 2001;258:177–83.

    Article  PubMed  CAS  Google Scholar 

  5. Vikram B, Strong EW, Shah JP, Spiro R. Second malignant neoplasms in patients successfully treated with multimodality treatment for advanced head and neck cancer. Head Neck Surg. 1984;6:734–7.

    Article  PubMed  CAS  Google Scholar 

  6. Sturgis EM, Miller RH. Second primary malignancies in the head and neck cancer patient. Ann Otol Rhinol Laryngol. 1995;104:946–54.

    PubMed  CAS  Google Scholar 

  7. Franchin G, Minatel E, Gobitti C, Talamini R, Vaccher E, Sartor G, Politi D, Trovo MG, Barzan L. Radiotherapy for patients with early-stage glottic carcinoma: univariate and multivariate analyses in a group of consecutive, unselected patients. Cancer. 2003;98:765–72.

    Article  PubMed  Google Scholar 

  8. Lee JH, Machtay M, McKenna MG, Weinstein GS, Markiewicz DA, Krisch RE, Kligerman MM. Radiotherapy with 6-megavolt photons for early glottic carcinoma: potential impact of extension to the posterior vocal cord. Am J Otolaryngol. 2001;22:43–54.

    Article  PubMed  CAS  Google Scholar 

  9. Panosetti E, Luboinski B, Mamelle G, Richard JM. Multiple synchronous and metachronous cancers of the upper aerodigestive tract: a nine-year study. Laryngoscope. 1989;99:1267–73.

    Article  PubMed  CAS  Google Scholar 

  10. Day GL, Blot WJ. Second primary tumors in patients with oral cancer. Cancer. 1992;70:14–9.

    Article  PubMed  CAS  Google Scholar 

  11. Haughey BH, Gates GA, Arfken CL, Harvey J. Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol. Ann Otol Rhinol Laryngol. 1992;101:105–12.

    PubMed  CAS  Google Scholar 

  12. Jones AS, Morar P, Phillips DE, Field JK, Husband D, Helliwell TR. Second primary tumors in patients with head and neck squamous cell carcinoma. Cancer. 1995;75:1343–53.

    Article  PubMed  CAS  Google Scholar 

  13. Di Martino E, Sellhaus B, Hausmann R, Minkenberg R, Lohmann M, Esthofen MW. Survival in second primary malignancies of patients with head and neck cancer. J Laryngol Otol. 2002;116:831–8

    PubMed  Google Scholar 

  14. Lin K, Patel SG, Chu PY, Matsuo JM, Singh B, Wong RJ, Kraus DH, Shaha AR, Shah JP, Boyle JO. Second primary malignancy of the aerodigestive tract in patients treated for cancer of the oral cavity and larynx. Head Neck. 2005;27:1042–8.

    Article  PubMed  Google Scholar 

  15. • Chuang SC, Scelo G, Tonita JM, Tamaro S, Jonasson JG, Kliewer EV, Hemminki K, Weiderpass E, Pukkala E, Tracey E, Friis S, Pompe-Kirn V, Brewster DH, Martos C, Chia KS, Boffetta P, Brennan P, Hashibe M. Risk of second primary cancer among patients with head and neck cancers: A pooled analysis of 13 cancer registries. Int J Cancer. 2008;123:2390–6. This is an important review on risk factors of second primary tumors, using population-based cancer registry data.

    Article  PubMed  CAS  Google Scholar 

  16. Rennemo E, Zätterström U, Boysen M. Impact of second primary tumors on survival in head and neck cancer: an analysis of 2,063 cases. Laryngoscope. 2008;118:1350–6.

    Article  PubMed  Google Scholar 

  17. León X, del PradoVenegas M, Orús C, López M, García J, Quer M. Influence of the persistence of tobacco and alcohol use in the appearance of second neoplasm in patients with a head and neck cancer. A case-control study. Cancer Causes Control. 2009;20:645–52

    Article  PubMed  Google Scholar 

  18. Priante AVM, Carvalho AL, Kowalski LP. Second primary tumor in patients with upper aerodigestive tract cancer. Braz J Otorhinolaryngol. 2010;76:251–6.

    PubMed  Google Scholar 

  19. Franco EL, Kowalski LP, Kanda JL. Risk factors for second cancers of the upper respiratory and digestive systems: a case-control study. J Clin Epidemiol. 1991;44:615–25.

    Article  PubMed  CAS  Google Scholar 

  20. Slaughter DP, Southwick HW, Smejkal W. “Field cancerization” in oral stratified squamous epithelium. Cancer. 1953;6:963–8.

    Article  PubMed  CAS  Google Scholar 

  21. Kowalski LP, Batista MB, Santos CR, Scopel AA, Salvajoli JV, Novaes PE, Trippe N. Prognostic factors in glottic carcinoma clinical stage I and II treated by surgery and radiotherapy. Am J Otolaryngol. 1993;14:122–7.

    Article  PubMed  CAS  Google Scholar 

  22. Warren S; Gates O. Multiple primary malignant tumors: a survey of the literature and a statistical study. Am J Cancer. 1932;16:1358–403

    Google Scholar 

  23. Sirtori C, Leonardelli GB, Parolari P. Plurifocalitá del cancro laringeo e significato di recidiva: studio istopatologico su cento casi. Arch Ital Oto’ Rinol Laringol. 1963;74:483–98.

    CAS  Google Scholar 

  24. Ballantyne AJ. Principles of surgical management of cancer of the pharyngeal walls. Cancer. 1967;20:663–7.

    Article  PubMed  CAS  Google Scholar 

  25. Auerbach O, Stout AP, Hammond EC, Garfinkel L. Changes in bronchial epithelium in relation to cigarette smoking and in relation to lunng cancer. New Engl J Med. 1961;265:253–67.

    Article  PubMed  CAS  Google Scholar 

  26. Incze J, Vaughan CW Jr, Lui P, Strong MS, Kulapaditharom B. Premalignant changes in normal appearing epithelium in patients with squamous cell carcinoma of the upper aerodigestive tract. Am J Surg. 1982;144:401–5.

    Article  PubMed  CAS  Google Scholar 

  27. Califano J, van der Riet P, Westra W, Nawroz H, Clayman G, Piantadosi S, Corio R, Lee D, Greenberg B, Koch W, Sidransky D. Genetic progression model for head and neck cancer: implications for field cancerization. Cancer Res. 1996;56:2488–92.

    PubMed  CAS  Google Scholar 

  28. Hong WK, Lippman SM, Itri LM, Karp DD, Lee JS, Byers RM, Schantz SP, Kramer AM, Lotan R, Peters LJ, et al. Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med. 1990;323:795–801.

    Article  PubMed  CAS  Google Scholar 

  29. Khuri FR, Lee JJ, Lippman SM, Kim ES, Cooper JS, Benner SE, Winn R, Pajak TF, Williams B, Shenouda G, Hodson I, Fu K, Shin DM, Vokes EE, Feng L, Goepfert H, Hong WK. Randomized phase III trial of low-dose isotretinoin for prevention of second primary tumors in stage I and II head and neck cancer patients. J Natl Cancer Inst. 2006;98:441–50.

    Article  PubMed  CAS  Google Scholar 

  30. Bairati I, Meyer F, Gélinas M, Fortin A, Nabid A, Brochet F, Mercier JP, Têtu B, Harel F, Mâsse B, Vigneault E, Vass S, del Vecchio P, Roy J. A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst. 2005;97:481–8.

    Article  PubMed  CAS  Google Scholar 

  31. van Zandwijk N, Dalesio O, Pastorino U, de Vries N, van Tinteren H. EUROSCAN, a randomized trial of vitamin A and N-acetylcysteine in patients with head and neck cancer or lung cancer. For the EUropean Organization for Research and Treatment of Cancer Head and Neck and Lung Cancer Cooperative Groups. J Natl Cancer Inst. 2000;92:977–86.

    Article  PubMed  Google Scholar 

  32. Mayne ST, Cartmel B, Baum M, Shor-Posner G, Fallon BG, Briskin K, Bean J, Zheng T, Cooper D, Friedman C, Goodwin WJ Jr. Randomized trial of supplemental beta-carotene to prevent second head and neck cancer. Cancer Res. 2001;61:1457–63

    PubMed  CAS  Google Scholar 

  33. Tincani AJ, Brandalise N, Altemani A, Scanavini RC, Valério JB, Lage HT, Molina G, Martins AS. Diagnosis of superficial esophageal cancer and dysplasia using endoscopic screening with a 2% lugol dye solution in patients with head and neck cancer. Head Neck. 2000;22:170–4.

    Article  PubMed  CAS  Google Scholar 

  34. Hashimoto CL, Iriya K, Baba ER, Navarro-Rodriguez T, Zerbini MC, Eisig JN, Barbuti R, Chinzon D, Moraes-Filho JP. Lugol’s dye spray chromoendoscopy establishes early diagnosis of esophageal cancer in patients with primary head and neck cancer. Am J Gastroenterol. 2005;100:275–82.

    Article  PubMed  Google Scholar 

  35. Kesting MR, Schurr C, Robitzky L, Steinstraesser L, Nieberler M, Baurecht H, Wolff KD, Loeffelbein DJ, Mücke T. Results of esophagogastroduodenoscopy in patients with oral squamous cell carcinoma--value of endoscopic screening: 10-year experience. J Oral Maxillofac Surg. 2009;67:1649–55.

    Article  PubMed  Google Scholar 

  36. Kesting MR, Robitzky L, Al-Benna S, Steinstraesser L, Baurecht H, Wolff KD, Hölzle F, Nieberler M, Mücke T, Loeffelbein DJ. Bronchoscopy screening in primary oral squamous cell carcinoma: a 10-year experience. Br J Oral Maxillofac Surg. 2009;47:279–83.

    Article  PubMed  Google Scholar 

  37. McGuirt WF, Matthews B, Koufman JA. Multiple simultaneous tumors in patients with head and neck cancer: a prospective, sequential panendoscopy study. Cancer. 1982;50:1195–9.

    Article  PubMed  CAS  Google Scholar 

  38. Leipzig B, Zellmer JE, Klug D. The role of endoscopy in evaluating patients with head and neck cancer. A multi-institutional prospective study. Arch Otolaryngol. 1985;111:589–94.

    PubMed  CAS  Google Scholar 

  39. Davidson J, Gilbert R, Irish J, Witterick I, Brown D, Birt D, Freeman J, Gullane P. The role of panendoscopy in the management of mucosal head and neck malignancy - a prospective evaluation. Head Neck. 2000;22:449–55.

    Article  PubMed  CAS  Google Scholar 

  40. Kerawala CJ, Bisase B, Lee J. Panendoscopy and simultaneous primary tumours in patients presenting with early carcinoma of the mobile tongue. Br J Oral Maxillofac Surg. 2009;47:363–5.

    Article  PubMed  Google Scholar 

  41. Guardiola E, Pivot X, Dassonville O, Poissonnet G, Marcy PY, Otto J, Poudenx M, Francois E, Bensadoun RJ, Thyss A, Demard F, Schneider M. Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan? Cancer. 2004;101:2028–33.

    Article  PubMed  Google Scholar 

  42. Shaha A, Hoover E, Marti J, Krespi Y. Is routine triple endoscopy cost-effective in head and neck cancer? Am J Surg. 1988;155:750–3.

    Article  PubMed  CAS  Google Scholar 

  43. •• Katada C, Tanabe S, Koizumi W, Higuchi K, Sasaki T, Azuma M, Katada N, Masaki T, Nakayama M, Okamoto M, Muto M. Endoscopy. Narrow band imaging for detecting superficial squamous cell carcinoma of the head and neck in patients with esophageal squamous cell carcinoma. Endoscopy. 2010 ;42:185–90. This study describes the most promising new method for early diagnosis of second primary tumors in the esophagus.

    CAS  Google Scholar 

  44. Upile T, Jerjes W, Sterenborg HJ, El-Naggar AK, Sandison A, Witjes MJ, Biel MA, Bigio I, Wong BJ, Gillenwater A, MacRobert AJ, Robinson DJ, Betz CS, Stepp H, Bolotine L, McKenzie G, Mosse CA, Barr H, Chen Z, Berg K, D’Cruz AK, Stone N, Kendall C, Fisher S, Leunig A, Olivo M, Richards-Kortum R, Soo KC, Bagnato V, Choo-Smith LP, Svanberg K, Tan IB, Wilson BC, Wolfsen H, Yodh AG, Hopper C. Head & neck optical diagnostics: vision of the future of surgery. Head Neck Oncol. 2009 Jul 13;1:25.

    Article  PubMed  Google Scholar 

  45. •• Haerle SK, Strobel K, Hany TF, Sidler D, Stoeckli SJ. (18)F-FDG-PET/CT versus panendoscopy for the detection of synchronous second primary tumors in patients with head and neck squamous cell carcinoma. Head Neck. 32(3):319–25, 2010. This study describes the impact of PET-CT on the diagnosis of second primary tumors, showing that it has more sensitivity but less specificity than panendoscopy.

    PubMed  Google Scholar 

  46. Strobel K, Haerle SK, Stoeckli SJ, Schrank M, Soyka JD, Veit-Haibach P, Hany TF. Head and neck squamous cell carcinoma (HNSCC)-detection of synchronous primaries with (18)F-FDG-PET/CT. Eur J Nucl Med Mol Imaging. 2009;36:919–27.

    Article  PubMed  Google Scholar 

  47. Homann N, Nees M, Conradt C, Dietz A, Weidauer H, Maier H, Bosch FX. Overexpression of p53 in tumor-distant epithelia of head and neck cancer patients is associated with an increased incidence of second primary carcinoma. Clin Cancer Res. 2001;7:290–6.

    PubMed  CAS  Google Scholar 

  48. Lei D, Sturgis EM, Liu Z, Zafereo ME, Wei Q, Li G. Genetic polymorphisms of p21 and risk of second primary malignancy in patients with index squamous cell carcinoma of the head and neck. Carcinogenesis. 2010;31:222–7.

    Article  PubMed  CAS  Google Scholar 

  49. Li F, Sturgis EM, Zafereo ME, Liu Z, Wang LE, Wei Q, Li G. p73 G4C14-to-A4T14 polymorphism and risk of second primary malignancy after index squamous cell carcinoma of head and neck. Int J Cancer. 2009;125:2660–5.

    Article  PubMed  CAS  Google Scholar 

  50. Zafereo ME, Sturgis EM, Aleem S, Chaung K, Wei Q, Li G. Glutathione S-transferase polymorphisms and risk of second primary malignancy after index squamous cell carcinoma of the head and neck. Cancer Prev Res (Phila). 2009;2:432–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Taubaté University, Av. Tiradentes, 241, Taubaté, Brazil, 12030-150

    Antonio Vitor Martins Priante

  2. Botucatu Medicine School, UNESP, Distrito de Rubião Júnior s/n, Botucatu, Brazil, 18618-970

    Emanuel Celice Castilho

  3. Department of Head and Neck Surgery and Otorhinolaryngology, Hospital A. C. Camargo, Rua Prof. Antonio Prudente, 211, São Paulo, Brazil, 01509010

    Luiz Paulo Kowalski

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  1. Antonio Vitor Martins Priante
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  2. Emanuel Celice Castilho
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  3. Luiz Paulo Kowalski
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Correspondence to Luiz Paulo Kowalski.

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Priante, A.V.M., Castilho, E.C. & Kowalski, L.P. Second Primary Tumors in Patients with Head and Neck Cancer. Curr Oncol Rep 13, 132–137 (2011). https://doi.org/10.1007/s11912-010-0147-7

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