A Narayana1, A T Vaughan, S G Fisher, S P Reddy. 1. Department of Radiation Oncology, Loyola University Medical Center and Hines V.A. Hospital, Maywood, IL 60153, USA.
Abstract
PURPOSE: The development of second primary tumors (SPTs) is the most important factor determining the survival in early-stage head and neck cancer patients, whose first tumor has been successfully treated. New methods of examining genetic changes have raised doubts about the validity of the widely held field cancerization hypothesis as the cause of SPTs, and an alternative hypothesis of monoclonal origin has been proposed. The objectives of this study were to look at the pattern of development of SPTs and the possible factors influencing the incidence of SPTs and the survival in early-stage laryngeal cancer with long-term follow-up. METHODS AND MATERIALS: One hundred forty-four consecutive patients of T1N0M0 squamous cell carcinoma of the true vocal cord treated with definitive radiotherapy between 1976 and 1992 were analyzed. The incidence, time to development, and survival of aerodigestive and other SPTs were noted. p53 overexpression indicating a mutated p53 gene was analyzed by immunohistochemistry. RESULTS: With a median follow-up of 6 years (range 2-20 years), 42 patients developed a SPT, 24 in upper aerodigestive tract and lung and 18 at other sites. The actuarial incidence of developing a SPT at 5, 10, and 15 years was 23%, 44%, and 48.7% respectively. The median time interval for development of SPT in an upper aerodigestive tract was 21 months as opposed to 50 months for other sites (p = 0.02). The most common sites of SPTs included lung for upper aerodigestive tract; and prostate, followed by colon, for other sites. The actuarial risk of developing a nonaerodigestive SPT at 5 and 10 years was 35% and 55% respectively. p53 status affected neither the incidence of SPT nor the survival. SPTs were the leading cause of death in these early-stage laryngeal cancer patients. CONCLUSION: The origin of SPTs seems to be multifactorial, involving both the field cancerization effect and an increased baseline genetic predisposition. Until more reliable genetic markers are developed, chemoprevention remains the best treatment option at preventing SPTs in these early-stage patients.
PURPOSE: The development of second primary tumors (SPTs) is the most important factor determining the survival in early-stage head and neck cancerpatients, whose first tumor has been successfully treated. New methods of examining genetic changes have raised doubts about the validity of the widely held field cancerization hypothesis as the cause of SPTs, and an alternative hypothesis of monoclonal origin has been proposed. The objectives of this study were to look at the pattern of development of SPTs and the possible factors influencing the incidence of SPTs and the survival in early-stage laryngeal cancer with long-term follow-up. METHODS AND MATERIALS: One hundred forty-four consecutive patients of T1N0M0 squamous cell carcinoma of the true vocal cord treated with definitive radiotherapy between 1976 and 1992 were analyzed. The incidence, time to development, and survival of aerodigestive and other SPTs were noted. p53 overexpression indicating a mutated p53 gene was analyzed by immunohistochemistry. RESULTS: With a median follow-up of 6 years (range 2-20 years), 42 patients developed a SPT, 24 in upper aerodigestive tract and lung and 18 at other sites. The actuarial incidence of developing a SPT at 5, 10, and 15 years was 23%, 44%, and 48.7% respectively. The median time interval for development of SPT in an upper aerodigestive tract was 21 months as opposed to 50 months for other sites (p = 0.02). The most common sites of SPTs included lung for upper aerodigestive tract; and prostate, followed by colon, for other sites. The actuarial risk of developing a nonaerodigestive SPT at 5 and 10 years was 35% and 55% respectively. p53 status affected neither the incidence of SPT nor the survival. SPTs were the leading cause of death in these early-stage laryngeal cancerpatients. CONCLUSION: The origin of SPTs seems to be multifactorial, involving both the field cancerization effect and an increased baseline genetic predisposition. Until more reliable genetic markers are developed, chemoprevention remains the best treatment option at preventing SPTs in these early-stage patients.
Authors: Alfonso Medina-Banegas; José M Osete-Albaladejo; Alfonso Capitán-Guarnizo; Enrique López-Meseguer; Francisco Pastor-Quirante Journal: Eur Arch Otorhinolaryngol Date: 2002-12-19 Impact factor: 2.503
Authors: Jon Cacicedo; Arturo Navarro; Olga Del Hoyo; Alfonso Gomez-Iturriaga; Filippo Alongi; Jose A Medina; Olgun Elicin; Andrea Skanjeti; Francesco Giammarile; Pedro Bilbao; Francisco Casquero; Berardino de Bari; Alan Dal Pra Journal: Br J Radiol Date: 2016-08-02 Impact factor: 3.039
Authors: Félix Fernández Madrid; Robert L Karvonen; John Ensley; Michael Kraut; José L Granda; Huda Alansari; Naimei Tang; John E Tomkiel Journal: Cancer Detect Prev Date: 2005-01-28
Authors: Alfio Ferlito; Missak Haigentz; Patrick J Bradley; Carlos Suárez; Primož Strojan; Gregory T Wolf; Kerry D Olsen; William M Mendenhall; Vanni Mondin; Juan P Rodrigo; Carsten C Boedeker; Marc Hamoir; Dana M Hartl; Jennifer L Hunt; Kenneth O Devaney; Lester D R Thompson; Alessandra Rinaldo; Robert P Takes Journal: Eur Arch Otorhinolaryngol Date: 2013-04-17 Impact factor: 2.503
Authors: David I Rosenthal; Clifton D Fuller; Jerry L Barker; Bryan Mason; John A Garcia; Jan S Lewin; F Christopher Holsinger; C Richard Stasney; Steven J Frank; David L Schwartz; William H Morrison; Adam S Garden; K Kian Ang Journal: Int J Radiat Oncol Biol Phys Date: 2009-08-11 Impact factor: 7.038