Prognostic factors for head-and-neck with synchronous second cancer identified
MedWire News: Patients with head and neck cancer plus synchronous second cancers could benefit from aggressive treatment if they exhibit certain clinical characteristics, say researchers.
"The synchronous diagnosis of a head and neck tumor and a second cancer at another atomic site represents a difficult challenge," note Pierre Graff (Centre Alexis Vautrin, Vandoeuvre-Lès-Nancy, France) and colleagues.
"One option is to treat the most advanced tumor first, and more aggressively. Conversely, the earlier primary tumor may be considered highly curable with a quick initial management strategy," they explain in the journal Clinical Oncology.
The team reviewed the records of 43 patients treated radically at their clinic for head and neck plus synchronous second cancers between 1997 and 2009. Patients were aged a mean of 57.4 years, and 86.1% were male.
A total of 7.5% patients were severely underweight, 2.5% were underweight, and 55.0% were normal weight, according to World Health Organization body mass index classifications. The remainder were overweight (27.5%) and obese (7.5%).
The majority (26) of second cancers were located in the thoracic region (lung and trachea), while 14 patients had esophageal tumors.
Treatment modalities were complex, remark the researchers, and consisted of chemotherapy, radiotherapy, brachytherapy, and surgery.
In patients whose head, neck, and second cancers were both classified in the early stages (I-II; n=11), the first treatment targeted one tumor in 54.6% of cases, while in patients with both tumors categorized as advanced (stages III-IV; n=7), the first treatment frequently targeted the two tumors concomitantly (83.3%).
When tumors were of different stages (n=26), 15.4% of treatment protocols primarily targeted the earlier tumor, 30.8% the more advanced tumor, and 53.8% both tumors together.
A total of 31 (72.1%) patients died after a median 7.7-month follow-up, and the 3-year overall survival rate was 33.9%. Being underweight pre-treatment, and having advanced-stage second tumors and esophageal primary tumors were significant predictors of decreased survival after treatment.
Specifically, all underweight patients died within the first year after treatment, all patients with two advance-stage tumors died within 2 years of follow-up, and 2-year overall survival for patients with synchronous esophageal tumors was just 17.8% compared with 54.1% for those with second tumors in other locations.
"The final benefit for these patients, who completed long and strenuous treatments and died very early, should be questioned," comment Graff et al.
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By Sarah Guy