Second malignancies following organ preservation treatment for head and neck cancers

The development of multimodality treatment protocols, using combinations of chemotherapy and radiation with conservative surgery, has apparently accomplished effective treatment of head and neck cancer without a sacrifice in survival (Sturgis, Weiner & Miller, 1995; Sessions, et al., 2000). Unfortunately, an increase in the number of second primary malignancies has been the price of these treatments, with a higher incidence of multiple malignancies noted among head and neck sites. The present study examines the effect of organ preservation treatment for head and neck cancers on the incidence of second malignancies and on prognosis. Using raw cancer registry data from first primary malignancies in the head and neck from the Rocky Mountain Cancer Data Systems (RMCDS) database, the sample consisted of 1,902 patients with a second primary in the head and neck, 551 with a second in the esophagus, and 3,581 patients with a second in the lung. Results indicated a significantly greater number of second primaries among patients with localized (p < .01) and regional (p < .05) stage first primaries following organ preservation surgeries for their first cancers. Supplemental analyses revealed a significantly greater incidence of second primaries following radiotherapy of the first cancer (p < .001) overall. This significantly higher incidence of second primaries following radiotherapy persisted for Localized and Regional stage first cancers in the larynx and pharynx by age groups younger than 80 in the 1980s and 1990s, and localized stage but not regional stage oral first cancers treated with radiation. Confirmation of these findings in further studies is suggested, taking into account the factors of coexisting conditions, lifestyle and patient choice in treatment decision-making.