Screening for synchronous esophageal second primary tumors in patients with head and neck cancer

Abstract

Summary Patients with head and neck squamous cell carcinoma (HNSCC) have an increased risk of developing esophageal second primary tumors (ESPTs). We aimed to determine the incidence, stage, and outcome of synchronous ESPTs in patients with HNSCC in a Western population. We performed a prospective, observational, and cohort study. Patients diagnosed with HNSCC in the oropharynx, hypopharynx, any other sub-location in combination with alcohol abuse, or patients with two synchronous HNSCCs, between February 2019 and February 2020 underwent screening esophagogastroduodenoscopy (EGD). ESPT was defined as presence of esophageal squamous cell carcinoma (ESCC) or high grade dysplasia (HGD). Eighty-five patients were included. A lesion suspected for ESPT was detected in 14 of 85 patients, which was pathologically confirmed in five patients (1 ESCC and 4 HGD). The radiotherapy field was extended to the esophagus in two of five patients, HGD was treated with endoscopic resection in three of five patients. None of the ESPTs were detected on MRI and/or CT-scan prior to EGD. Of the remaining nine patients, three had low grade dysplasia on histology whereas the other six patients had benign lesions. Incidence of synchronous ESPT was 5.9% in our cohort of HNSCC patients. All ESPTs were diagnosed at an early stage and treated with curative intent. We recommend that screening for synchronous ESPTs should be considered in a selected group of patients with HNSCC.

Screening for head and neck tumors in patients with esophageal squamous cell carcinoma and vice versa: a nationwide survey among medical specialists

“…The expected incidence of 2 % to 10 % for synchronous ESPTs in this study is in line with that found in our previous screening study 17 . Our research group reported a 5.9 % (95 % confidence interval 1.9 %–13.2 %) incidence of ESPTs in 85 patients diagnosed with human papillomavirus-negative HNSCC located in the hypopharynx, oropharynx and other HN sublocations in patients with alcohol abuse in the Netherlands 17 .…”

“…Four of 10 medical specialists expected the prevalence of HNSPTs in ESCC patients and vice versa to be ≤ 3 % or ≥ 20 %. Median expectations of the prevalence of SPTs in ESCC and HNSCC patients of 5.0 % were comparable to numbers reported in recent studies [4,15,17]. Our research group performed a retrospective study with 9,058 ESCC patients in the Netherlands and found a 3.0 % prevalence of HNSPTs in patients with primary ESCC.…”

“…In Part 3, questions were asked about the possibility of implementing screening for SPTs in a Western country, including the arguments in favor (i. e. to improve early diagnosis of SPTs and increased patient survival) or against embarking on screening (i. e. increased patient burden, increased workload for specialists, more research needed, and limited knowledge of this subject). Next, information from two recent Dutch studies about the prevalence of SPTs in Western patients diagnosed with ESCC and HNSCC was provided ( Suppementary S1 ) 4 17 . With these data provided, the questions about whether screening for SPTs in ESCC and HNSCC patients should be implemented were repeated, including the reason for the chosen answer(s).…”

“…In retrospective studies in Western countries, at least 5 % of ESCC patients and 11 % of HNSCC patients developed an SPT 2 4 . The minority of published screening studies have been conducted in Western countries with esophageal second primary tumor (ESPT) rates ranging from 5.9 % to 10.0 % in patients with HNSCC 14 15 16 17 18 . No Western screening studies have been published on head and neck SPTs (HNSPTs) in patients with ESCC 3 .…”

Endoscopic Screening for Second Primary Tumors of the Esophagus Among Head and Neck Cancer Patients

“…In addition, the diagnostic sensitivity of NBI endoscopy (100.0%) was superior to whole body PET/CT (33.3%) in detecting esophageal SPTs ( 71 ). In a review of 14 studies with 2,743 HN cancer patients, IEE screening identified esophageal high grade dysplasia or invasive carcinoma in 13% (95% CI, 9-19% with a random effects model) of the patients ( Table 2 , Figure 3 ) ( 8 , 10 – 12 , 70 – 79 ). Most of the esophageal SPTs were at an early stage without tumor-related obstructive symptoms.…”