Synchronous and Metachronous Multiple Primary Laryngeal Malignancies

Abstract

The article reviews the literature on synchronous and metachronous multiple primary malignant laryngeal tumors of the same phenotype, of different phenotypes, and of different histogenesis.The development of a second or even third primary cancer involving the same system is not uncommon. For instance, the association of cancer of the larynx with lung cancer has been increasing and can be explained by the presence of common pathogenetic factors acting in the respiratory system.Multiple primary carcinomas of the larynx are not uncommon, but their exact incidence has not been clearly defined. The occurrence of an additional malignancy in the larynx should not necessarily be interpreted as a treatment failure for the initial laryngeal tumor, since the second tumor may represent a de novo primary malignancy. 'The frequency of primary or multicentric neoplastic areas in the larynx is relevant to research work on carcinogenesis and to clinical matters, such as the early detection of a second primary cancer in the respiratory tract.Patients who have had a primary cancer of the respiratory system are particularly prone to develop subsequent primary tumors elsewhere in this system. There is evidence that multiple synchronous tumors may involve the larynx -an observation that points up the relevance of the concept of "field cancerization" or "condemned mucosa" to this anatomic region.Two distinct synchronous or metachronous malignant tumors of the same histologie type (as, for example, tumors exhibiting squamous differentiation) are not rare in the larynx. Honcamp 2 observed 3 squamous carcinomas in the same larynx. Rabbet 3 reported 3 distinct primary cases of multicentric carcinoma of the larynx. Heiner 4 described a patient with 3 separate squamous carcinomas of the larynx. (The third primary malignant lesion was in situ carcinoma.) Thirty of 535 patients (5.6%) followed up over a 5-to 25-year period after treatment for carcinoma of the vocal fold developed a second primary laryngeal carcinoma. 5Second primary laryngeal cancer in limited (Tl or T2) glottic cancer has been observed in patients treated with different modalities -surgery or radiotherapy -and the incidence of a second primary laryngeal cancer is higher in the group of patients treated with surgery. In particular, in the group treated with surgery (118 patients), 9 of the 32 second primary cancers occurred in the larynx; in the group of irradiated patients (185 patients), 1 of the 23 second primary cancers occurred in the larynx. New malignancies occurring within the larynx were classified as second primary tumors if they occurred more than 5 years after treatment. 6

Salvage vertical partial laryngectomy for radiation failure in early glottic carcinoma

“…Two of our local recurrences were from a second primary within the larynx (contralateral vocal fold and ipsilateral supraglottis).The issue of multiple synchronous and metachronous primary laryngeal malignancy is discussed at length by Ferlito et al 31 . Fujita et al .found a second cancer developed in 22% of 158 patientstreated by radiotherapy for a T1 glottic cancer, 67% ofwhom developed one in the upper aero‐digestive tract 32 …”

Multiple Primary Tumors in Patients Diagnosed with Hypopharyngeal Cancer

“…The incidence of multiple primary tumors in patients with head and neck malignancy has a reported risk of between 3% and 7% after treatment of the index tumor 2 . The annual risk of developing multiple primary in patients with upper aerodigestive tract squamous cell carcinoma is thought to be between 1.5% and 5.1% 20,37 …”

“…2 The annual risk of developing multiple primary in patients with upper aerodigestive tract squamous cell carcinoma is thought to be between 1.5% and 5.1%. 20,37 Reporting on the incidence of multiple primary tumors in esophageal malignancies, Poon et al 38 found 100 patients with these tumors in 1055 patients studied. Of these, 47 had synchronous and 43 had metachronous tumors.…”

“…12,18,19 The majority of second primary tumors are squamous cell carcinomas, with adenocarcinoma accounting for less than 10% in most series. 4,10 Thus, most commonly, the synchronous or metachronous tumors are of the same histologic type (squamous cell carcinoma), 20 but it is also reported possible to simultaneously have tumors of a different histologic feature. [21][22][23][24][25][26][27][28][29] Confusion persists whether an isolated lung lesion that is diagnosed is best considered a second primary or a secondary metastasis.…”