Synchronous second primary tumors in 2,016 head and neck cancer patients: role of symptom-directed panendoscopy.

OBJECTIVES/HYPOTHESIS: Second primary tumors (SPTs) are prevalent in head and neck cancer patients. Synchronous SPTs occur within the first 6 months after diagnosis of a first primary tumor. Work-up of first primary head and neck cancers may include panendoscopy if SPTs are suspected. It is unclear whether this strategy has significant impact on treatment results. STUDY
DESIGN: Prospectively recorded data on head and neck cancer patients treated at an academic tertiary referral center.
METHODS: The distribution of SPTs was retrieved from a database of 2,016 patients with head and neck cancer. Initial work-up included panendoscopy when an SPT was clinically suspected.
RESULTS: Of 2,016 patients, 49 (2.4%) had synchronous SPTs. Of these, there were 26 diagnosed simultaneously with the first primary tumor, of which 18 (69%) were located in areas covered by panendoscopy. The remaining 23 were nonsimultaneous synchronous SPTs; 10 of them were located at sites accessible by panendoscopy, of which 6 were in the bronchial tree. Median survival after simultaneous SPTs was 9 months versus 3 months after nonsimultaneous synchronous SPTs (P = not significant). The highest frequency of synchronous SPTs was seen with first primary tumors of the hard palate, the dorsum of the tongue, and of the mandibular gingiva.
CONCLUSIONS: Symptom-directed panendoscopy at initial work-up was successful at finding SPTs of the upper aerodigestive tract, but not SPTs located in the lower airways. Synchronous SPTs missed at initial work-up did not have significantly worse prognosis than simultaneous SPTs.