MULTIPLE PRIMARY LUNG CANCERS

Between 1970 and 1990, of 1287 patients undergoing resection for prima ry lung cancer, we considered 55 (4.3 %) to have a second primary lung cancer, being synchronous in 15 cases (1.2 %) and metachronous in 40 (3.1 %). Two patients had a third primary lung cancer. The 15 patients with synchronous cancers were all treated surgically: ten underwent a two-stage procedure and 5 patients a one-stage. In 6 patients the can cers were located bilaterally and in 4 patients both synchronous cance rs had a different histology. There were 3 postoperative deaths (20 %) . The 3- and 5-year actuarial survival rates were 26 % and 15 %. Of th e 40 patients with metachronous cancers the mean interval between trea tment of their first and second cancer was 5 years and 11 months. It w as longer for the 21 patients having a contralateral second localizati on (7 years) than for those having an ipsilateral localization (4 year s). There was no dependence of the intervals on whether or not the sec ond cancer had the same histology as the first cancer. In 7 patients t he second cancer was treated by chemo- and/or radiotherapie and in 33 patients by surgery. There were 5 postoperative deaths in this group ( 15.2 %). The 3- and 5-year actuarial survival rates were 33 % and 18 % . For 25 patients with a stage I or II second cancer these rates were 42 % and 27 %; all 8 patients with a stage III second cancer died with in 14 months. Survival was positively affected by: histological type d iffering between both cancers, an interval of more than 3 years, a bil ateral localization, and a stage I or II second cancer. In conclusion, a close follow-up including a regular chest radiograph of operated lu ng-cancer patients is necessary and in case of a new primary lung canc er precise clinical staging; an aggressive surgical approach is indica ted in Stage I and II second cancers.