The role of thorax imaging in staging head and neck squamous cell carcinoma

The overall survival rate for patients with head neck squamous cell carcino ma remains disappointingly static despite improved locoregional control. Th is has been attributed to the development of distant metastases and second primary malignancies in these patients, a large proportion of which occur i n the thorax. We retrospectively analysed the incidence of thoracic malignancies in 138 p atients presenting with newly diagnosed (n = 107) or recurrent (n = 31) can cer of the head and neck over a 4-year period. All 138 patients had undergo ne both computerised tomography of the thorax (CT) and conventional chest r adiography within one month of presenting with biopsy proven squamous cell carcinoma. Seventeen percent of these were found to have simultaneous thoracic maligna ncies. CT thorax was more sensitive in detecting simultaneous thoracic mali gnancies compared with standard chest X-ray (24/138 versus 9/138, odds rati o of 3: 1 in favour of CT). All thoracic malignancies detected by chest X-r ay were also detected by CT thorax. Patients presenting with recurrent tumo rs were significantly more likely to have simultaneous thoracic malignancie s than those with newly diagnosed cancer (11/31 versus 13/107, chi(2) test with Yates correction, chi(2) = 4.66, p = 0.03). The primary site (laryngeal, oral or pharyngeal) or presence of nodal disea se did not have an effect on the incidence of simultaneous thoracic maligna ncies. The presence of distant metastases and second primary malignancies has majo r implications in the management and prognosis of patients presenting with head and neck squamous cell carcinoma, with a large proportion of such pati ents succumbing to their disease within one year of diagnosis. As CT scanni ng of the thorax was a more effective screening investigation than standard chest X-ray in the detection of simultaneous thoracic malignancy, we recom mend it for use in the staging of patients presenting with cancer of the he ad and neck. (C) 1999 European Association for Cranio-Maxillofacial Surgery .