Management of synchronous lung nodules in patients with potentially curable head and neck cancer

Abstract

16503 The presence of a solitary pulmonary nodule in patients with otherwise curable head and neck cancer is a complex clinical scenario. We retrospectively reviewed the management of such patients at the Dallas VA Medical Center to determine if our process for selecting patients to treat with curative intent was in fact identifying patients with meaningful survivals. All patients presented at the institutional multimodality head and neck tumor board from 1998 - 2004 were reviewed. This insured more than 24 months follow up for each patient. Included patients had head and neck cancer that was felt to be potentially curable with either surgery and/or radiation or a combination of chemotherapy and radiation. In addition, all had a solitary lung nodule that was biopsy proven and potentially resectable lung cancer. Pretreatment imaging included CT scans of the head and neck and chest. Patients all had adequate renal, pulmonary, and performance status to tolerate planned treatment for their head and neck cancer and thoracotomy for their lung cancer. In all cases, the head and neck cancer was addressed first followed by treatment of the lung cancer. Twelve patients were identified with potentially curable head and neck cancer and a synchronous solitary pulmonary nodule that was biopsy proven lung cancer. Six of these patients were determined to be candidates for aggressive treatment of both cancers. The pathologic stage, survival, and management for the 6 patients were as follows: The synchronous occurrence of potentially curable head and neck and lung cancers was uncommon in our population. Using stringent criteria for selection of patients who might benefit from an aggressive approach to both cancers, we achieved reasonable outcomes with a median survival for the group of 29 months and with 4/6 patients (67%) surviving more than 2 years. Curative intent therapy should be offered to appropriately selected patients. [Table: see text] No significant financial relationships to disclose.