Metachronous cancer: Prognostic factors including prior irradiation

In this article we evaluate two factors that may be responsible for the rep orted increased mortality rate in metachronous cancers: prior radiation the rapy and stage at presentation. A select group of 358 patients was split in to three groups: no prior cancer (group 1), prior cancer treated with radia tion therapy (group 2), and prior cancer treated with surgery alone (group 3). We compared survival among the three groups according to stage (T1 or T 2 vs. T3 or T4) using the Lifetest procedure. Survival in patients with adv anced (T3 or T4) cancers was uniformly poor, and survival in patients with low-staged (T1 or T2) cancers was disproportionately poor only for patients in group 2. Metachronous cancers are not necessarily more lethal, except w hen the cancer arises within prior irradiated tissue. Initial treatment dec isions for patients with primary cancers must always provide for the contin gency of a metachronous cancer, and the judicious use of radiation therapy is essential.