title: Multiple primary malignancies: analysis of 23 patients with at least three tumors.
abstract: BACKGROUND
  There is scarcity of reports addressing patients with three or more malignancies. The aim of this study is to present a detailed analysis of patients presenting with at least three primary malignant tumors.
  
  
  METHODS
  Records of cancer patients presenting to King Hussein Cancer Center (Amman, Jordan) between June 2006 and March 2011 were retrospectively reviewed. Patients harboring multiple primary tumors were included for detailed analysis. Data relating to epidemiological features, pathological characteristics, and disease outcomes were extracted.
  
  
  RESULTS
  Out of 14,040 cases, 319 patients (2.3%) harbored two or more while 23 patients (0.16%) harbored three or more primary malignant tumors. This study included 17 males and six females between 4 and 78 years of age (median, 52 years) at the time of diagnosis of the first malignancy. The most prevalent tumor was colorectal adenocarcinoma found in nine, followed by lymphoma in seven, and prostate adenocarcinoma in six patients. The most common tumor combinations were colorectum-non-melanoma skin, colorectum-kidney, and non-melanoma skin-kidney all found in four patients, respectively. At a median follow-up of 96 months from the time of diagnosis of the first primary (range, 2-337 months) and 8 months from the time of diagnosis of the last primary (range, 1-48 months), 13 were alive with no evidence of disease, six were alive with residual disease, three were dead due to disease, and one patient was alive with unknown disease status.
  
  
  CONCLUSIONS
  The possibility of multiple primary malignancies should always be considered during the treatment and follow-up of cancer patients. This case series could prove helpful to clinicians faced with similar, however, exceedingly rare scenarios. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients.
authors.affiliation: Department of Radiation Oncology, King Hussein Cancer Center, HM Queen Rania Street, P.O. Box 1269, Amman, 11941, Jordan.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.forename: Ramiz
authors.initials: R
authors.lastname: Abu-Hijlih
authors.forename: Fadwa
authors.initials: F
authors.lastname: Abdelrahman
authors.forename: Rim
authors.initials: R
authors.lastname: Turfa
authors.forename: Rula
authors.initials: R
authors.lastname: Amarin
authors.forename: Naim
authors.initials: N
authors.lastname: Farah
authors.forename: Maher
authors.initials: M
authors.lastname: Sughayer
authors.forename: Abdelatief
authors.initials: A
authors.lastname: Almousa
authors.forename: Jamal
authors.initials: J
authors.lastname: Khader
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007597:Jordan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult