MULTIPLE PRIMARY MALIGNANT-TUMORS IN PATIENTS WITH HEAD AND NECK-CANCER - RESULTS OF A PROSPECTIVE-STUDY AND FUTURE PERSPECTIVES

Multiple primary tumors are a known phenomenon in head and neck cancer , They are partially responsible for the limited improvement in surviv al of head and neck cancer during the past 20 years. Only a few prospe ctive data have been published about the incidence of metachronous tum ors, The authors prospectively studied 127-patients with squamous cell carcinoma of the head and neck, The overall incidence of second prima ry tumors was 13.5% (simultaneously, 3%; synchronously, 5.5%; and meta chronously, 8%). More than 90% of the recurrences of the first primary tumor occurred within the first 2 years following primary treatment, but the second primary tumors continued to occur gradually in the cour se of follow-up, Most of the second primary tumors were discovered bec ause the patients developed symptoms (14/17). Survival after detection of the second primary tumor was poor, The development of a second pri mary tumor was of equivalent prognosis to a recurrence of the primary tumor. Future directives include the development of more adequate scre ening methods, Identification of potential early markers for the devel opment of a squamous cell carcinoma at the level of the mucosa at risk and in serum could be of value for the early detection of individuals at risk.