CHEST COMPUTERIZED-TOMOGRAPHY SCANNING IN PATIENTS PRESENTING WITH HEAD AND NECK-CANCER

Between 1 to 16% of patients with head and neck squamous cell carcinom a (HNSCC) have synchronous tumours; the majority (>50%) occurring with in the lung. Previous studies have relied upon endoscopy and chest rad iographs. The aim of this study was to determine the incidence of sync hronous intrapulmonary tumours in this group of patients using compute rized tomography (CT) scanning. Over 36 months, 111 consecutive patien ts were assessed at presentation by contrast enhanced CT scanning from the skull base to the diaphragm. Chest scans showed intrapulmonary le sions in 17 patients and 10 have, with time, been confirmed as neoplas tic. These allowed treatment of three primary bronchial carcinomas fol lowing radical treatment of the index tumour and cancellation of radic al treatment in five patients with metastases. Two patients with possi ble metastases at presentation underwent radical treatment to the inde x tumour with subsequent follow-up confirming metastatic chest disease . All 10 patients eventually died of either locoregional or metastatic disease. This is one of the first prospective reports of chest scanni ng in patients with head and neck cancer. An additional chest scan in this group, many of whom undergo a staging scan of the neck, requires an extra 10 min with no further contrast and in this study yielded a s ynchronous tumour rate of 9%.