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; Steffi E. M. van de Ven; Pieter Jan F. de Jonge; Wilmar de Graaf; Manon C. W. Spaander; Suzan Nikkessen; Jose A. Hardillo; Aniel Sewnaik; Dominiek A. Monserez; Hetty Mast; Stijn Keereweer; Marco J. Bruno; Robert J. Baatenburg de Jong; Arjun D. Koch

doi:10.1055/a-2111-5935

Endoscopy, Table of Contents

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

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Steffi E. M. van de Ven

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Pieter Jan F. de Jonge

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Wilmar de Graaf

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Manon C. W. Spaander

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Suzan Nikkessen

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Jose A. Hardillo

²Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Aniel Sewnaik

²Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Dominiek A. Monserez

²Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Hetty Mast

³Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Stijn Keereweer

²Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Marco J. Bruno

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Robert J. Baatenburg de Jong

²Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

,

Arjun D. Koch

¹Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands

› Author Affiliations

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.

Full Text

References

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Supplementary Material

Supplementary material