The group of patients with the highest risk of a second primary tumor was younger patients with limited initial tumors. A high proportion of patients who later developed a second primary were complete responders after treatment of the first tumor. However, prognosis was poor after the actual diagnosis of the second primary tumor.

Symptom-directed panendoscopy at initial work-up was successful at finding SPTs of the upper aerodigestive tract, but not SPTs located in the lower airways. Synchronous SPTs missed at initial work-up did not have significantly worse prognosis than simultaneous SPTs.

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Outcome was poor after the date of the local failure. No difference in survival was seen whether the failure was a local recurrence or a second primary tumor. The similarity in survival and pattern of presentation suggests that these two entities may be biologically analogous.

Objectives 1) Evaluate what impact second primary tumors have on prognosis in HNSCC. 2) Identify patients that run the highest risk of obtaining a second primary tumor after successful treatment of primary HNSCC. Methods A retrospective analysis of 2063 patients treated over a 15-year period for tumors of the oral cavity, larynx, oropharynx, and hypopharynx, was undertaken. Survival was analysed for the group of patients presenting second primary tumors, and the descriptive characteristics of these patients were compared to the remaining group of patients. Results Second primary tumors correlated with low patient age (p=0.02), less advanced disease (p<0.05), and were more common after primary tumors of the larynx and oral cavity. Mean time to diagnosis of a second primary tumor was more than 4 years from the date of the initial tumor. From the date of primary tumor treatment, overall median survival among patients that later developed second primary tumors compared to all other patients was 6 years vs. 3 years. Prognosis was poor after the diagnosis of a second primary, as median survival was 12 months and 5-year survival, 16%. Conclusions Patients at risk of a second primary tumor were younger than median with stage I and II primary tumors of the larynx and the oral cavity. This group had a favorable outcome after treatment of their primary tumor and therefore initially a better overall survival. However, after diagnosis of the second tumor, prognosis was extremely poor.