Background: It is not infrequent that patients with HNC are also diagnosed with primary non-small cell lung cancer (NSCLC). The presence of a synchronous (SLC) or metachronous lung cancer (MLC) greatly complicates the treatment decisions and overall prognosis. We describe the local experience of HNC with SLC and MLC.
Methods: Patients were identified from a database of confirmed HNC patients known to have a second primary NSCLC.
Results: 34 eligible HNC patients were identified. 15 patients had SLC and 19 patients had MLC. The median follow-up of all patients was 39 months (4 – 275). Only 2/15 patients were symptomatic from SLC and all were incidentally diagnosed on staging of HNC. 13/15 patients received curative intent treatment for HNC followed by treatment for lung cancer. 6/15 patients in SLC group were in complete remission, 5 patients had died (3 due to NSCLC, 2 HNC) and 4 patients were alive with progressive disease (3 NSCLC, 1 HNC).
19 patients had MLC with a median of 47 months (11-259) between a diagnosis of HNC and diagnosis of MLC. 42% of patients were symptomatic from MLC at diagnosis. At the time of follow-up, 12 patients had died, 3 patients were alive with disease and 4 patients had been lost to follow up. Lung cancer was the main reason for death or progressive disease in the majority of patients. Median survival from the time of lung cancer diagnosis was 13 months in the overall population, with a trend to better survival with SLC (15 vs 11 months for MLC, p=0.11).
Conclusion: Second primary lung malignancies in HNC should be discussed and managed in tertiary hospitals with a multidisciplinary approach on an individualized basis. Aggressive management can still result in respectable long term disease control rates particularly in SLC patients.