Lung cancer after head and neck cancer: Role of chest radiography

Objective: To examine whether screening chest radiographs lead to significa ntly longer life span in patients found to have pulmonary lesions than in t hose in whom lung cancer was detected after symptoms developed. Study Desig n: A retrospective study. Material and Methods: Charts of 1086 patients wit h squamous cell cancer of the head and neck treated for cure from January 1 , 1974, to December 31, 1998, were analyzed. Results: Pulmonary cancer deve loped in 62 patients. In 41 patients pulmonary malignancy was found because of patient symptoms, In 21 patients lung cancer was detected by routine an nual chest radiography, Seventy-five percent of lung cancers were detected within 3 years of initial treatment of the head and neck cancer. Conclusion : Chest radiography is a poor screening tool, because it failed to find pul monary lesions in more than 65% (41/62) of patients who were later found to have pulmonary cancer. Survival rate did not differ between patients in wh om pulmonary cancer was found by screening chest radiography and those in w hom symptoms prompted evaluation (P = .48), Using current treatment protoco ls, routine yearly chest radiography did not improve survival in patients w ith head and neck cancer. However, there maybe new therapeutic regimens und er investigation that would benefit these patients if their lung cancers we re found in early stages of disease, Future directives must include the est ablishment of an effective follow-up protocol for the early detection of lu ng malignancies in these patients.