Second laryngeal cancers in previously treated larynges.

OBJECTIVES: To review the management and outcome of patients with new second primary cases of laryngeal cancer occurring more than 3 years after the initial cancer was treated. STUDY
DESIGN: Retrospective review of 855 patients with newly diagnosed and treated laryngeal cancers.
METHODS: Charts were reviewed and tabulated for occurrence of second primary laryngeal tumors, method of treatment for the index and second primary laryngeal tumors, and effect of smoking status or cessation of smoking.
RESULTS: Of the 855 patients, 532 patients retained their larynx; of these 377 lived more than 3 years and thus were at risk for a second new primary cancer. Of these 377 patients at risk, 19 or 5.1% developed second primary tumors. The rate of second primary disease was lower in patients whose index laryngeal cancer was treated by irradiation (4.3%) compared with those treated surgically (9.2%). However, surgical treatment of second primary laryngeal tumors resulted in far higher rates of laryngeal voicing (82%) compared with irradiation (33%).
CONCLUSION: When possible, management of the index primary tumor by endoscopic resection has resulted in the highest future retention of laryngeal speech, leaving all treatment options available should a second laryngeal cancer occur. Lifelong follow-up of patients with laryngeal cancer for secondary primary tumors is important. Second primary tumors were equally distributed between patients who continued to smoke and ceased to smoke after their index primary lesion was diagnosed.