Abstract
In the period from April, 2004 to March, 2010, we retrospectively reviewed 286 patients who were newly-diagnosed as squamous cell carcinoma of the head and neck (HNSCC), in order to investigate the incidence of multiple primary malignancies and the overall survival rate of such patients, and the therapeutic strategy to deal with them.
In 83 patients (29%) other primary malignancies were revealed, 35 patients (12%) synchronously and 48 patients (17%) metachronously. The 5-year overall survival rates shown with the Kaplan-Meier method were 74% for single primary malignancy, and 49% and 70% for synchronous and metachronous multiple malignancies, respectively. The overall survival of patients with synchronous multiple malignancies was significantly worse than those with single primary malignancy, while the difference between single and metachronous cases was not significant. The therapeutic strategies for synchronous multiple malignancies were decided according to the following policies. 1) Treatment of more advanced cancer went ahead when simultaneous treatments of both malignancies were difficult. 2) As simultaneous operation for both lesions was considered if safely possible. 3) An endoscopic resection for the other gastrointestinal tract malignancy could be performed at a convenient time for HNSCC treatment. 4) The choice of synchronous or metachronous radiation for multiple lesions depended on the total range of radiation fields and the purpose of treatment. Upper gastrointestinal endoscopy and FDG-PET are recommended in patients with untreated HNSCC, because the ratio of synchronous primary malignancy was as high as 12%. Although synchronous multiple malignancies including HNSCC should be considered according to the stage and the location of each lesion, we discuss the relevant therapeutic strategies.
