Di Martino Ercole, Sellhaus Bernd, Hausmann Ralf, Minkenberg Ralf, Lohmann Melanie, Esthofen Martin W
Department for ENT Diseases and Plastic Head and Neck Surgery, University of Aachen, Germany.
J Laryngol Otol. 2002 Oct;116(10):831-8. doi: 10.1258/00222150260293664.
Second primary tumours occur frequently in patients with a history of head and neck malignancies. Delays in making an early and correct diagnosis can seriously affect the therapy management and survival. This was a retrospective study of 120 patients with a history of head and neck cancer, presenting with a second primary tumour. Current follow-up strategies and the use of routine sonographic imaging of the head and neck regions were evaluated, and the impact that tumour chronology, the tumour site and the various treatment modalities have on the survival were assessed. Forty-two per cent of patients developed a metachronous second malignancy more than five years after diagnosis of the index tumour. The accuracy of colour-duplex sonography in detection of second primaries in the head and neck was 82.3 per cent. First and second primary tumours located in the larynx were observed to have the highest five-year survival rate. Patients who developed metachronous tumours had a five-year survival rate of 68.9 per cent for the index tumours, and a 26 per cent five-year survival rate with the occurrence of a second neoplasm. With synchronous tumours a mean survival time of 18 months and a five-year survival rate of 11.9 per cent was found (p < 0.0001). Where clinically appropriate an aggressive treatment strategy was employed and yielded the most favourable results with a five-year survival rate of 66.8 per cent and 35.9 per cent for index tumours and second primary malignancies, respectively. Since more than 40 per cent of the metachronous second primaries in patients with a history of head and neck malignancy occur beyond the five-year follow-up period, an extended protocol with individually adjusted close monitoring of high-risk patients seems appropriate. Colour-duplex sonography is a valuable screening investigation for the early detection of second primary tumours. The treatment of a second primary is often less successful than for the same malignancy occurring primarily. The prognosis of synchronous tumours is significantly lower when compared to malignancies of a metachronous nature, despite some encouraging individual results. Only the early implementation of aggressive treatment methods for second primaries is successful in terms of survival.
第二原发性肿瘤在有头颈部恶性肿瘤病史的患者中频繁发生。早期正确诊断的延迟会严重影响治疗管理和生存。这是一项对120例有头颈部癌病史且出现第二原发性肿瘤的患者的回顾性研究。评估了当前的随访策略以及头颈部区域常规超声成像的应用，并评估了肿瘤发生时间、肿瘤部位和各种治疗方式对生存的影响。42%的患者在索引肿瘤诊断五年后发生异时性第二恶性肿瘤。彩色双功超声检测头颈部第二原发性肿瘤的准确率为82.3%。观察到位于喉部的第一和第二原发性肿瘤的五年生存率最高。发生异时性肿瘤的患者，索引肿瘤的五年生存率为68.9%，出现第二肿瘤时的五年生存率为26%。对于同时性肿瘤，平均生存时间为18个月，五年生存率为11.9%（p<0.0001）。在临床合适的情况下采用积极的治疗策略，索引肿瘤和第二原发性恶性肿瘤的五年生存率分别为66.8%和35.9%，取得了最有利的结果。由于有头颈部恶性肿瘤病史的患者中超过40%的异时性第二原发性肿瘤发生在五年随访期之后，对高危患者进行单独调整的密切监测的扩展方案似乎是合适的。彩色双功超声是早期检测第二原发性肿瘤的有价值的筛查检查。第二原发性肿瘤的治疗通常不如原发性相同恶性肿瘤的治疗成功。尽管有一些令人鼓舞的个体结果，但与异时性恶性肿瘤相比，同时性肿瘤的预后明显更低。就生存而言，只有早期对第二原发性肿瘤实施积极的治疗方法才是成功的。
