Head and neck cancer survivors at high risk for second primary lung cancer
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Survivors of head and neck cancer appeared at increased risk for a second primary lung cancer, according to results of an ad hoc secondary analysis of a randomized trial published in JAMA Otolaryngology-Head & Neck Surgery.
The findings support regular low-dose CT screening among survivors of head and neck cancer who have a significant cigarette smoking history and are fit to receive curative-intent treatment, researchers noted.
“I was treating patients in clinic with head and neck cancer and wondered how frequently to obtain imaging after patients finish treatment. In my practice, we have widespread variation in the frequency of imaging after treatment among different providers that see this population of patients,” John D. Cramer, MD, assistant professor in the department of otolaryngology and head and neck surgery at Karmanos Cancer Institute at Wayne State University, told Healio. “After treatment for their cancer, we often consider imaging of the neck and chest as survivors are at risk for distant metastases or second primary lung cancer because both share smoking as a primary risk factor. I had read about the National Lung Screening Trial and wondered whether it enrolled participants who had prior head and neck cancer and how this group fared compared with other participants.”
The ad hoc analysis of the randomized National Lung Screening Trial included 53,452 enrolled participants (mean age, 61 years; 77.2% men). Among them, 82 of 171 survivors of head and neck cancer underwent low-dose CT screening of the chest and 89 underwent chest radiography. The trial participants, aged between 55 and 74 years, had at least a 30 pack-year history of cigarette smoking, still smoked or had quit within the previous 15 years, and had a high-risk for lung cancer.
Incidence of a second primary lung cancer served as the primary outcome.
Results showed survivors had higher lung cancer incidence compared with 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 that these survivors may be at a slightly higher risk, but I was surprised by the magnitude of elevated risk for head and neck cancer survivors compared with other cancer survivors or those who have never had cancer,” Cramer said.
Among survivors of head and neck cancer, a second primary lung cancer occurred in 2,610 cases per 100,000 person-years in the low-dose CT group vs. 1,594 cases per 100,000 person-years in the chest radiography group (rate ratio = 1.55; 95% CI, 0.59-3.63).
Moreover, survivors who underwent low-dose CT had an OS of 7.07 years compared with 6.66 years for chest radiography.
“Lung cancer screening with low-dose CT appears superior to chest radiography in this population,” Cramer said. “Currently, only 14% of smokers who are eligible for lung cancer screening receive appropriate screening. These results should push all clinicians caring for patients with head and neck cancer to ensure these patients receive appropriate screening.”
Future research will entail examination of the risks and benefits of screening for head and neck cancers, he added.
“We have a paucity of high-level evidence to guide screening patients at risk for developing head and neck cancer or screening survivors after completing treatment. Screening could include direct inspection of the head and neck or imaging,” Cramer said.
For more information:
John D. Cramer, MD, can be reached at Wayne State University, 4201 St. Antoine, UHC 5E, Detroit, MI 48201; email: jdcramer@med.wayne.edu.
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