Head and neck cancer survivors at high risk for second primary lung cancer


January 07, 2022

2 minutes to read

Disclosures:
Cramer does not report any relevant financial disclosures. Please see the study for relevant financial information from all other authors.


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According to the results of an ad hoc secondary analysis of a randomized trial published in JAMA Otorhinolaryngology-Head and neck surgery.

The results support regular low-dose CT scans of head and neck cancer survivors who have a significant history of smoking and are fit for curative treatment, the researchers noted.

Quote from John D. Cramer, MD.

“I treated patients with head and neck cancer in the clinic and wondered how often to get imaging after the patients were finished treatment. In my practice, we have a large variation in the frequency of post-treatment imaging among the different providers who see this patient population ”, John D. Cramer, MD, said Healio, assistant professor in the department of otolaryngology and head and neck surgery at the Karmanos Cancer Institute at Wayne State University. “After their cancer has been treated, we often consider imaging of the neck and chest because survivors are at risk of distant metastasis or a second primary lung cancer, as both share smoking as a primary risk factor. . I had read articles about the National Lung Screening Trial and wondered if it recruited participants who had previously had head and neck cancer and how this group fared compared to other participants.

The ad hoc analysis of the national randomized lung screening trial included 53,452 enrolled participants (mean age, 61 years; 77.2% male). Of these, 82 of 171 head and neck cancer survivors underwent low-dose chest CT scans and 89 underwent a chest x-ray. The trial participants, aged 55 to 74, had at least 30 packs of years of smoking, still smoked or had quit in the past 15 years, and were at high risk for lung cancer.

The incidence of a second primary lung cancer was used as the primary outcome.

The results showed that survivors had a higher incidence of lung cancer than participants without head and neck cancer (2,080 per 100,000 person-years [2.1%] vs. 609 per 100,000 person-years [0.6%]; adjusted rate ratio = 2.54; 95% CI, 1.63-3.95).

“I thought these survivors may have been at a slightly higher risk, but I was surprised at the magnitude of the high risk for head and neck cancer survivors compared to other cancer survivors or those who have never had cancer, ”Cramer said.

Among head and neck cancer survivors, a second primary lung cancer occurred in 2,610 cases per 100,000 person-years in the low-dose CT group compared to 1,594 cases per 100,000 person-years in the chest x-ray group (rate ratio = 1.55; 95% CI, 0.59-3.63).

In addition, the survivors who underwent a low-dose CT scan had OS of 7.07 years compared with 6.66 years for the chest x-ray.

“Screening for lung cancer with a low-dose CT scan appears to be superior to a chest x-ray in this population,” Cramer said. “Currently, only 14% of smokers eligible for lung cancer screening benefit from appropriate screening. These findings should prompt all clinicians caring for patients with head and neck cancer to ensure that these patients receive appropriate screening. “

Future research will include examining the risks and benefits of screening for head and neck cancers, he added.

“We have little high-level evidence to guide the screening of patients at risk of developing head and neck cancer or the screening of survivors after treatment has ended. Screening could include direct head and neck inspection or imaging, ”Cramer said.

For more information:

John D. Cramer, MD, can be contacted at Wayne State University, 4201 St. Antoine, UHC 5E, Detroit, MI 48201; email: [email protected]


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