CLINICAL CHARACTERISTICS OF PATIENTS WITH RARE DOUBLE PRIMARY CANCERS INVOLVING THE LUNG AND ESOPHAGUS: A SYSTEMATIC REVIEW

Abstract

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Investigate the available published data on the clinical characteristics, treatment, and outcomes of patients diagnosed with double primary cancers (DPCs) of the lung and esophagus. METHODS: PubMed, Medline, ScienceDirect, and Scopus literature search, from database inception through June 30, 2020, for “lung cancer” and “esophageal cancer,” pooled with a case from our institution. RESULTS: We included 15 patients. The male: female ratio (14:1). The mean age at first primary cancer diagnosis (FPCd) was 60 (range:38-78 years), with ten patients (75%) being 60 years of age or younger. Of those, 85.7% and 42.8% had tobacco smoking and alcohol abuse history, respectively. The most common symptoms were dysphagia and weight loss in 50% and 20% of patients at the time of FPCd, respectively, and 64% and 22% of patients at the time of second primary cancer diagnosis (SPCd), respectively. DPCs were metachronous in 60% of patients (9/15) with a mean interval between FPCd and SPCd of 46.6 (range 0-192 months). Twelve patients (80%) had lung FPC, who later developed esophageal SPC. The most common locations were the left lung, right lung, and middle thoracic esophagus (MTE) in 46.1%, 38.5, and 15.4% of FPCd patients, respectively, compared to the distal esophagus, right lung, and MTE in 57.0%, 21.5%, 21.5% of SPCd patients, respectively. At the time of FPCd, cancer was at stage I, II, and III in 62.5%, 25%, and 12.5% of patients, respectively; with no distant metastasis in 100% of patients, whereas SPC was at stage III, I, II, and IV in 38.5%, 30.7%, 23.1%, and 7.7%, respectively. Treatment modality for FPC was surgery, surgery plus chemotherapy, chemotherapy, chemoradiation, and surgery plus chemoradiation in 60.0%, 13.3%, 13.3%, 6.7%, and 6.7%, respectively. In contrast, SPC was treated with surgery, surgery plus chemotherapy, chemoradiation, and surgery plus chemoradiation in 71.5%, 14.3%, 7.1%, and 7.1%, respectively. The mean duration of follow-up was 18.9 (range 0.5-108 months). In terms of outcomes, six (50%) were alive and disease-free, two (16.7%) were alive with disease, one (8.3%) was alive with recurrence, and three (25%) died of the disease. CONCLUSIONS: In our cohort, several findings are noteworthy. First, three-fourths of the patients were 60 years of age or younger at the time of FPCd; all had no distant metastasis. Second, Lung cancer was the most common FPCd in 80% of patients. Third, the most common overall treatment modality was surgery in both FPC and SPC. Here we highlight the unique characteristics of DPCs of the lung and esophagus. Their entwined perplexed management makes them even more challenging. A high index of clinical suspicion for a SPC would improve early detection, management, and outcomes. CLINICAL IMPLICATIONS: This study's findings would expand our knowledge, enhance accurate evaluation, and promote multidisciplinary management strategies, that will eventually reshape outcomes. DISCLOSURES: No relevant relationships by Dawood Findakly, source=Web Response