CC BY 4.0 · Endoscopy 2023; 55(11): 981-990
DOI: 10.1055/a-2111-5935
Original article

Endoscopic screening of the upper gastrointestinal tract for second primary tumors in patients with head and neck cancer in a Western country

Laurelle van Tilburg 
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Steffi E. M. van de Ven 
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Pieter Jan F. de Jonge
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Wilmar de Graaf
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Manon C. W. Spaander 
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Suzan Nikkessen
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Jose A. Hardillo
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Aniel Sewnaik
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Dominiek A. Monserez
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Hetty Mast
3   Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Stijn Keereweer
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Marco J. Bruno
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Robert J. Baatenburg de Jong
2   Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
,
Arjun D. Koch 
1   Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
› Author AffiliationsSupported by: The Dutch Digestive Foundation SK 18–12

Trial Registration: Netherlands National Trial Register (http://www.trialregister.nl) Registration number (trial ID): NL7299 Type of study: Prospective
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Author commentary on Laurelle van Tilburg et al.Endoscopy 2023; 55(11): v35-v35
DOI: 10.1055/a-2119-0453

Abstract

Background Patients with head and neck squamous cell carcinoma (HNSCC) can develop second primary tumors (SPTs) in the esophagus. Endoscopic screening could lead to detection of SPTs at early stages and improve survival.

Methods We performed a prospective endoscopic screening study in patients with curably treated HNSCC diagnosed between January 2017–July 2021 in a Western country. Screening was performed synchronously (< 6 months) or metachronously (≥ 6 months) after HNSCC diagnosis. Routine imaging for HNSCC consisted of flexible transnasal endoscopy with positron emission tomography/computed tomography or magnetic resonance imaging, depending on primary HNSCC location. The primary outcome was prevalence of SPTs, defined as presence of esophageal high grade dysplasia or squamous cell carcinoma.

Results 202 patients (mean age 65 years, 80.7 % male) underwent 250 screening endoscopies. HNSCC was located in the oropharynx (31.9 %), hypopharynx (26.9 %), larynx (22.2 %), and oral cavity (18.5 %). Endoscopic screening was performed within 6 months (34.0 %), 6 months to 1 year (8.0 %), 1–2 years (33.6 %), and 2–5 years (24.4 %) after HNSCC diagnosis. We detected 11 SPTs in 10 patients (5.0 %, 95 %CI 2.4 %–8.9 %) during synchronous (6/85) and metachronous (5/165) screening. Most patients had early stage SPTs (90 %) and were treated with curative intent with endoscopic resection (80 %). No SPTs in screened patients were detected with routine imaging for HNSCC before endoscopic screening.

Conclusion In 5 % of patients with HNSCC, an SPT was detected with endoscopic screening. Endoscopic screening should be considered in selected HNSCC patients to detect early stage SPTs, based on highest SPT risk and life expectancy according to HNSCC and comorbidities.

Tables 1 s, 2s, Fig. 1 s–3 s



Publication History

Received: 16 March 2023

Accepted after revision: 15 June 2023

Accepted Manuscript online:
16 June 2023

Article published online:
25 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

Unveiling the hidden threat: esophageal squamous cell neoplasm in patients with head and neck squamous cell carcinomaEndoscopy 2024; 56(02): 157-157
DOI: 10.1055/a-2219-2993

 

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