Multiple Primary Cancers in NTUH Patients with Cancer of the Head and Neck

Patients with cancer of the head and neck have been described to be particularly susceptible to the development of new cancers. To help our understanding of this issue, we evaluated all head and neck patients with multiple primary cancers in National Taiwan University Hospital (NTUH). A retrospective chart review with correlation of cancer registry records showed that second primary malignancies developed in 136 patients till Dec. 1991. Five of them had three separate cancers. Ninety eight of 136 had their first head and neck primary during 1977-1991 among 7,475 patients, providing the occurrence rate of 1.31%. The other 38 patients had their first cancer diagnosed before 1977. The median time to the development of a second malignant tumor was 4.58 years, with a maximum interval of 29.75 years. Most of the patients (110 in 136) developed a second cancer metachronously. A total of 91 (66.9%) patients had their second cancer in the head and neck, esophagus or lung. Second primary malignancies were most commonly associated with nasopharyngeal index tumors (62 in 136), nearly all of which (60 in 62) received radiation therapy; followed by laryngeal cancers (25 in 136), of which 16 had radiation therapy or surgery plus radiation therapy. In both nasopharyngeal and laryngeal index tumor groups, head and neck region was the most common site of multiple primary cancers.