Is the second primary malignancy an important competing cause of death in patients (pts) with squamous cell head and neck cancer (SCHNC)?
5516 Background: The development of a 2nd (or 3rd) primary malignancy (SPM) is a well recognized problem in pts with SCHNC. Although the prognosis of such pts is not well defined, SPM is felt to be an important competing cause of death.We retrospectively reviewed our registry of 222 SCHNC pts treated with definitive chemoradiotherapy (CRT) between 1989-2002, to identify those pts with SPM, and define their clinical characteristics and outcomes. All pts received 4-day continuous intravenous 5-fluorouracil (1000 mg/m2/day) and cisplatin (20 mg/m2/day) during the 1st and 4th weeks of either qd or bid radiation.There were 55 SPM identified in 45 pts; 10 were synchronous and 45 were metachronous (13 before and 32 after the index SCHNC). The projected Kaplan-Meier (KM) cumulative incidence of SPM developing after the index SCHNC is 20% at 5 years. Of the 55 SPM, 35 (64%) were upper aerodigestive tract(UADT) cancers: 19 lung cancers (13 squamous cell), 13 SCHNC, and 3 esophageal cancers (1 squamous cell). There were 37 pts with SPM occurring synchronous or subsequent to the index SCHNC. When these 37 are compared to the other 185 pts with no synchronous or subsequent SPM, there is no difference in the 5-year KM overall survival (65% in both groups, P=0.37), at a median follow up of 55 (range 2-166) months. The survival curves subsequently diverge, however, with survival at 6 years of 51% vs. 62%, and at 7 years of 41% vs. 59% respectively. Once the diagnosis of a synchronous or subsequent SPM is made, the 3 year projected KM survival is 52%. There were 19 SPM of lung in 18 pts, all either synchronous with or subsequent to the index SCHNC. Eight (42%) were Stage I, and definitive treatment was possible in 12 of 18 pts. After diagnosis of a SPM of lung, these 18 pts had a 3-year KM projected survival of 55%.Pts treated for SCHNC are at risk for development of SPM, predominantly involving the UADT. The prognosis for these pts is better than expected, perhaps reflecting early diagnosis, and justifying aggressive management. The survival of pts in CRT trials reporting < 5 years of follow-up is not likely impacted by the development of a SPM. No significant financial relationships to disclose.
Tso, E; Adelstein, DJ; Rybicki, LA; Saxton, JP; Esclamado, RM; Wood, BG; Strome, M; Carroll, MA
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