CT Lung Screening in Patients with Laryngeal Cancer

Abstract

Laryngeal cancer (LC) patients who meet the age and smoking criteria of the U.S. Preventive Services Task Force (USPSTF) for annual CT lung screening were analysed for pulmonary nodules (PN) detection and secondary lung cancer (SLC) diagnosis. This is a retrospective chart review of LC patients treated at Johns Hopkins Hospital from January 2010 to December 2017. The study population included patients who met USPSTF criteria by age and smoking history for annual chest screening and were followed for at least 3 consecutive years. A total of 998 LC patients' records were reviewed, of which 151 met the inclusion criteria. Inadequate follow-up period (37% of excluded cases) was the most common reason for exclusion, followed by not meeting USPSTF age criteria (27% excluded cases). In seventy-eight patients (n = 78, 52% of analysed patients) PN were reported. Nine individuals (6% of analysed patients) were diagnosed with SLC. Age over 70 (p = 0.003) was an independent predictor of malignancy. White race and smoking history over 40 pack-years were positively associated with a pulmonary nodule detection (p = 0.037 and p = 0.044, respectively). The incidence of PN and SLC in patients with LC is high. Many patients with laryngeal cancer meet the formal guidelines for USPSTF screening, and should be screened annually according to evidence-based medicine for the early detection of secondary lung cancers.Approximately 13,150 new cases of laryngeal cancer (LC) are diagnosed every year in the USA 1 . The most pronounced risk factors remain tobacco smoking and alcohol consumption 2 , and the 5 year overall survival has not changed significantly over the last 20 years and it is currently estimated at approximately 60% 1 . One of the significant reasons for the reduced overall survival is that the incidence of secondary primary lung cancer (SPLC) in patients affected by LC ranges from 5 to 19% 3-6 , which has a significant impact on outcome. The risk of pulmonary nodules is even higher and has been reported to be up to 58% 7 in head and neck cancer (HNC) patients.One of the national attempts to reduce the smoking-related mortality was the introduction of the U.S. Preventive Services Task Force (USPSTF) recommendations for annual lung cancer screening with low-dose CT in a group of high-risk smokers. This screening program has proven to prevent a significant number of lung cancer-related deaths in patients who received three CT scans over the course of two years. The USPSTF recommends annual chest imaging with low-dose CT for adults aged 55-80, with at least 30 pack-years smoking history in current smokers or those who have quit within the past 15 years 8 . However, one of the exclusion criterion of the large clinical trials 9 justifying implementation of screening program was previously known malignancy. Practically, this meant that HNC patients with substantial smoking history and obvious cancer predisposition were excluded.The aim of this study was therefore to assess the frequency of incidental findings on CT screening such as ...

Factors associated with the development of second primary tumours in head and neck cancer patients

“…(a) For each risk factor evaluated in this review, the number of articles that studied that factor (n) and the number of articles that found a significant association for that factor (n 0 ) is provided. (b) A summary of the quality of the articles according to their study design is provided With regards to comparability, only 4 out of the 38 studies did not get the maximum score; three because the authors did not perform multivariate analysis (Bukovszky et al, 2022;Piersiala et al, 2020;Sawaf et al, 2022), and another one because they did not mention the variables included in the multivariate analysis (Watanabe et al, 2017).…”

Analysis of the interactions between small pulmonary nodules, clinical factors and the risk of malignancy in the chest following diagnosis of head and neck cancer

“…Negative p16 status is associated with developing metastasis in the chest in oropharyngeal cancer. 4. Small indeterminate pulmonary nodules on staging may subsequently be shown to represent malignancy in patients with head and neck cancer.…”

“…Staging for HNC commonly involves cross‐sectional imaging of the chest and pulmonary nodules can be identified in this context in more than 50% of cases 3,4 . The chest is one of the most common sites for metastatic disease in HNC.…”

“…1,2 Staging for HNC commonly involves cross-sectional imaging of the chest and pulmonary nodules can be identified in this context in more than 50% of cases. 3,4 The chest is one of the most common sites for metastatic disease in HNC. There is also an increased risk of synchronous primary malignancy in the chest in patients with HNC due to common risk factors such as smoking.…”

Voice Quality and Laryngeal Findings in Patients With Suspected Lung Cancer

“…In a study of such patients, 52% had pulmonary nodules, and 6% were diagnosed with lung cancer. 6 In addition, the National Comprehensive Cancer Network guidelines recommend chest imaging as part of the workup for newly diagnosed head and neck cancers to evaluate for distant metastases and second primary lesions. 7 According to the logic of field cancerization, patients with lung cancer are also at risk for developing second primary cancers of the head and neck.…”