Abstract
Purpose
The aim of the present study was to compare the incidence, patterns, and survival of second primary malignancy (SPM) in patients with squamous cell carcinoma of the larynx (LSCC) and hypopharynx (HPSCC).
Methods
We retrospectively review the medical record of 581 previously untreated patients with LSCC (392 cases) and HPSCC (189 cases) who received primary surgery with or without postoperative radiotherapy from 1990 to 2000. Data including age, sex, risk factors, subsites and TNM stage of primary tumor, treatment, site and incidence of SPM, and prognosis were collected from medical charts.
Results
Groups with HPSCC had a higher incidence (4.2% vs 2.9% annual rate) and shorter median time (30 vs 59 months) developing SPM rather than LSCC. Fifty-five percent of the SPM occurred in the respiratory axis in LSCC, and 66% developed in the digestive axis in HPSCC. The factors influencing the appearance of SPM included early T stage, tobacco use, and less tumor recurrence. Long-term survival was poorer in those with than without SPM (38% vs 49% at 10 years).
Conclusions
There is a tendency for SPM to occur in the respiratory axis (lung and larynx) in LSCC and in the digestive axis (oral cavity, pharynx, and esophagus) in HPSCC. This information is important for posttreatment follow-up.
1
Introduction
More than 90% of the patients with squamous cell carcinoma of the head and neck (HNSCC) have the history of tobacco and alcohol exposure. There is a strong tendency of developing second primary malignancy (SPM) in the mucous membranes of the aerodigestive tract . The reported incidence of SPM in the HNSCC is around 10% to 40% and with a 4% to 6% annual development rate .
Although the locoregional control of the head and neck cancer had improvement in recent decades, there was only a minimal improvement of the long-term survival of these patients because of development of distant metastasis and SPM . The SPM is the main failure pattern of patients with satisfactory local-regional and distant control, especially for the early-stage diseases, and it has been shown to have a significant impact on survival .
Patients with squamous cell carcinoma of the larynx (LSCC) and hypopharynx (HPSCC) have similar risk factors of carcinogenesis; however, the tumor biology and prognosis are much different . It is interesting to examine and better understand the incidence and localization of SPM in these patients. The purpose of this study is to determine the incidence, pattern, and survival of SPM in patients with LSCC and HPSCC after treatment.
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