Primary and second primary cancer in 649 patients with malignancies of the maxillofacial region.

Aim: The aim of this study was to analyse the outcome of patients with oral and maxillofacial (OMF) cancer. The emphasis was to evaluate the outcome of patients with second primary cancer.

Patients And Methods: A total of 649 patients were retrospectively evaluated (male: 457; female: 192). All patients were treated for a primary cancer at the department of OMF surgery, Eppendorf University Hospital, Germany. All patients were reclassified (UICC TNM-system, 1992). The follow-ups were analysed separately for primary and second primary cancer.

Results: Seventy-seven of 649 patients developed a second cancer (11.9%; male: 50; female: 27). Second primaries were synchronous (18.2%) or metachronous (76.6%; necropsy: 5.2%). The index tumor was located in the OMF region in 49 patients (63.6%). The incidence of second cancer inside the OMF region was 49 cases (7.5% of all patients). The mean survival differed significantly between patients with one cancer and those with two (127 months vs. 48 months p < 0.001). However, these differences were not significant when survivals were calculated with diagnosis of the index tumor as the reference time-point. About a third of second primaries in the OMF region succeeded a primary of other organs.

Conclusion: Patients who develop second cancer are younger than single OMF cancer patients at the time-point they acquire their index tumor. Successful therapy for a primary cancer that had developed inside or outside the OMF region expands the life-span of cancer patients. These patients are at risk of developing second primaries. Inspection of the upper aerodigestive tract should be included in the follow-up of cancer patients who survive cancer that originated in other organs. Tumor markers are needed to define this subgroup of cancer patients.