Systematic esophageal endoscopy screening in patients previously treated for head and neck squamous-cell carcinoma

Background: An attempt was made to improve metachronous oesophageal cancer prognosis through bi-annual systematic esophageal endoscopy screening in pa tients treated for head and neck cancer. Patients and methods: Bi-annual esophageal endoscopy, without a staining pr ocedure, was performed in 1560 patients from 1987 to 1997. The distribution of previous head and neck cancer was oral cavity (20%), oropharynx (30%), hypopharynx (34%), and larynx (16%). All patients had initial panendoscopic inspection before HNSCC treatment. Esophageal tumors were considered to be second synchronous primaries when discovered within the first six months o f initial tumor diagnosis. Results: Fifty metachronous esophageal asymptomatic cancers (42 T-1 and 7 i n situ carcinomas) were diagnosed by endoscopy. The median time between the HNC and the esophageal carcinoma was 43 months (7-137 months). Metachronou s esophageal carcinoma was discovered in 2.6% of patients with oral cavity tumor, 5.7% of patients with oropharynx tumor, 2.3% of patients with hypoph arynx tumor, and 1.7% of patients with larynx tumor. Causes of death were: 41.1% related to esophageal tumor with tumor progression, metastatic evolut ion, or treatment toxicity; 28.9% related to non malignant causes; 26.6% re lated to a cancer that was not of esophageal origin. Conclusions: Over a 10-year period, systematic bi-annual esophageal endosco py uncovered metachronous esophageal tumors in 3.2% of 1560 patients origin ally treated for head and neck carcinoma, developing in a median time of 47 months. Patients with initial oropharyngeal tumors had a significantly hig her risk of metachronous esophageal SCC, compared to the other tumor sites (P < 0.02 with Fisher exact test). Given the elevated death rate not relate d to the esophageal cancer and the median survival of 16 months, any potent ial benefit from this time-consuming procedure is debatable.