A study of second primary cancers in head and neck cancer cases in south India.

Abstract

e16031 Background: Second primary (SP) in head and neck cancers accounts for 4-7% of cases. This reflects the possible role of same etiology for SP. Methods: Objectives: To determine the possible etiology in Indians; study the tumor site and chronology; study prognosis with respect to disease control and 3 yr survival. Study design: Retrospective study. Study period :1997 to 2007. Total cases: 32. Follow up: minimum 6 months or until death. ClassifySP: synchronous (Syn) or metachronous (Meta) (Warren and Gates). Diagnosis based on panendoscopy, histopathology. Treatment (Rx): In Syn Primary Simultaneous CTRT (chemoradiation); index tumors in meta: Combined modality. Nonsimultaneous Syn or Meta SP: surgery ±RT (radiotherapy) or CTRT or supportive therapy. Meta SP:Surgery ±CT (chemotherapy). Follow up protocol: Every 2 mths for 1st yr,3 mthly for 2nd yr,4 mthly for 3rd yr, and 6 mthly for life. Results: Incidence of SP 3.34%. Males 72%. Age 43-80 yrs. (mean 61). Follow up : 6 mths to 9 yrs (mean 22 months). Etiology: tobacco and alcohol in 64% of cases, only tobacco in 26%, only alcohol in 4%, and rest unknown. Types SP: Syn 12 (5 simultaneous lesions) and Meta 20. Table shows tumor sites. HPE of index and SP: all squamous cell carcinomas (Ca) except 3 cases; 2 papillary ca. and 1 anaplastic ca. of thyroid. Common Meta Chronology: HP and E in 31% ; OC and HP in 23% and L&B in 18% cases. Stage of primary tumor was mainly stage III and Meta was stage II. Rx : We had 5 cases of simultaneous Syn SP tumors: 3 cases refused treatment and 2 CTRT. Nonsimultaneous SP (7 ) and Meta SP (20) underwent surgery in 6 cases, surgery + RT in 7, CTRT in 12 and supportive therapy in 2 cases. Prognosis of SynSP is poor. Only 2 cases survived > 2 yrs rest died < 1 yr. In 20 cases of Meta SP, <1yr survival for 2 cases, 1-3 yrs for 5 cases, and 13 cases survived >3 yrs. Conclusions: S P cancers is diagnostic and therapeutic dilemma to the oncologist. In India tobacco and alcohol are the common etiology. Esophagus is a common SP site. Regular follow-up is mandatory for Meta SP. Though the prognosis is poor; early detection and treatment can lead to a better quality of life. Tumor sites Index tumor site (%) S P site (%) Larynx (L) 25 9 Oral cavity (OC) 22 16 Hypopharynx (HP) 19 16 Oropharynx 13 13 Thyroid 9 0 Esophagus (E) 6 25 Bronchus (B) 6 9 Miscellaneous 0 12 No significant financial relationships to disclose.