Primary lung cancer after treatment of head and neck cancer without lymph node metastasis: is there a role for autofluorescence bronchoscopy?
BACKGROUND
Head and neck cancer (HNC) is the 5th most common cancer worldwide. As good locoregional tumor control can be achieved with current treatment strategies, patients who develop second primary tumors from field cancerization have poorer prognosis.


OBJECTIVE
To determine if autofluorescence bronchoscopy (AF) played a role in the detection of second primary lung cancer (SPLC), and impact of SPLC on survival of patients with HNC and no cervical lymph node metastasis (N0).


METHODS
Patients with HNC(N0) referred for symptoms and/or radiology suspicious for lung cancer were assessed with AF. Data on patient demographics, smoking, cancer characteristics, and outcome were prospectively collected.


RESULTS
Fifty-one patients (44 males) with curatively treated HNC(N0) were evaluated. Median age was 70 years, all were current or former smokers of 35 pack years, and 25 had chronic obstructive lung disease. Over a median follow up of 60 months, 8 patients were diagnosed with synchronous and 26 with metachronous SPLC. Forty-two SPLC were found; 12 (29%) affected the tracheobronchial tree and 30 (71%) involved the lung parenchyma. Median time to metachronous SPLC was 22 months. Most of SPLC were surgically resectable. Five radiographically occult lung cancers detected by AF were successfully treated with endobronchial therapy. Lung cancer mortality was 24%. HNC patients who developed synchronous and metachronous SPLCs had significantly shorter survival (51 and 144 months) compared to those without (240 months) (p=0.0005).


CONCLUSIONS
SPLC impacted negatively on the survival of patients with HNC. Close surveillance with AF and CT for SPLC combined with aggressive treatment of early stage lung cancer might be a strategy to improve outcome.
Lee
Pyng
P
Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. lee.pyng@sgh.com.sg
de Bree
Remco
R
Brokx
Hes A P
HA
Leemans
C René
CR
Postmus
Pieter E
PE
Sutedja
Tom G
TG
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis / Q000188:drug therapy; D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000188:drug therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005453:Fluorescence; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000188:drug therapy; D012907:Smoking; D015996:Survival Rate; D016896:Treatment Outcome