RISK OF THIRD AND FOURTH TUMORS IN PATIENTS WITH HEAD AND NECK CANCER

Background. The objective of our study was to analyze the incidence and location of second and subsequent tumors in patients after an index head and neck carcinoma. Methods. A retrospective study was made by reviewing clinical data prospectively collected from 3631 patients with head and neck cancer. Incidence, location, and histology of the second, third, and fourth tumors was evaluated. Results. During the follow-up, 839 second tumors, 147 third tumors, and 35 fourth tumors were diagnosed. The annual hazard ratio was 3.8% for second tumors, 5.1% for third tumors, and 7.8% for fourth tumors. The risk of second and subsequent neoplasms remained constant throughout the follow-up. There were significant differences in the risk of appearance between the second and third tumors (p < .0001), and between the third and fourth tumors (p = .005). Conclusion. Patients with a second tumor after an index head and neck carcinoma have an increased risk for developing subsequent tumors. (C) 2010 Wiley Periodicals, Inc. Head Neck 32: 1467-1472, 2010