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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

 

  • References

  • 1 Bugter O, van Iwaarden DLP, Dronkers EAC. et al. Survival of patients with head and neck cancer with metachronous multiple primary tumors is surprisingly favorable. Head Neck 2019; 41: 1648-1655
    CrossrefPubMedGoogle Scholar
  • 2 Overwater A, Rueb K, Elias SG. et al. Esophageal second primary tumors in patients with head and neck squamous cell carcinoma: incidence, risk factors, and overall survival. Am J Gastroenterol 2022; 117: 794-797
    CrossrefPubMedGoogle Scholar
  • 3 van de Ven SEM, de Graaf W, Bugter O. et al. Screening for synchronous esophageal second primary tumors in patients with head and neck cancer. Dis Esophagus 2021; 34: doab037
    CrossrefPubMedGoogle Scholar
  • 4 Bugter O, van de Ven SEM, Hardillo JA. et al. Early detection of esophageal second primary tumors using Lugol chromoendoscopy in patients with head and neck cancer: a systematic review and meta-analysis. Head Neck 2019; 41: 1122-1130
    CrossrefPubMedGoogle Scholar
  • 5 Zhang N, Li Y, Chang X. et al. Long-term effectiveness of one-time endoscopic screening for esophageal cancer: a community-based study in rural China. Cancer 2020; 126: 4511-4520
    CrossrefPubMedGoogle Scholar
  • 6 Gong EJ, Kim DH, Ahn JY. et al. Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study. Dis Esophagus 2016; 29: 752-759
    CrossrefPubMedGoogle Scholar
  • 7 Thakur K, Singh CA, Thakar A. et al. Prevalence of synchronous ESCN in head and neck cancer: a single-institution perspective. Laryngoscope 2021; 131: E807-E14
    CrossrefPubMedGoogle Scholar
  • 8 Arnold M, Ferlay J, van Berge Henegouwen MI. et al. Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut 2020; 69: 1564-1571
    CrossrefPubMedGoogle Scholar
  • 9 Morimoto M, Nishiyama K, Nakamura S. et al. Significance of endoscopic screening and endoscopic resection for esophageal cancer in patients with hypopharyngeal cancer. Jpn J Clin Oncol 2010; 40: 938-943
    CrossrefPubMedGoogle Scholar
  • 10 Lee YC, Wang CP, Chen CC. et al. Transnasal endoscopy with narrow-band imaging and Lugol staining to screen patients with head and neck cancer whose condition limits oral intubation with standard endoscope (with video). Gastrointest Endosc 2009; 69: 408-417
    CrossrefPubMedGoogle Scholar
  • 11 Fukuhara T, Hiyama T, Tanaka S. et al. Characteristics of esophageal squamous cell carcinomas and Lugol-voiding lesions in patients with head and neck squamous cell carcinoma. J Clin Gastroenterol 2010; 44: e27-33
    CrossrefPubMedGoogle Scholar
  • 12 Chen YH, Wang YK, Chuang YS. et al. Endoscopic surveillance for metachronous esophageal squamous cell neoplasms among head and neck cancer patients. Cancers (Basel) 2020; 12: 3832
    CrossrefPubMedGoogle Scholar
  • 13 Dutch Society of Gastroenterologists. Guideline esophageal cancer (in Dutch: Richtlijn Oesofaguscarcinoom), version 3.1. Available at (Acessed 06/22/2023): https://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/Richtlijn_Oesofaguscarcinoom.pdf
    PubMedGoogle Scholar
  • 14 Săftoiu A, Hassan C, Areia M. et al. Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2020; 52: 293-304
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Petit T, Georges C, Jung GM. et al. Systematic esophageal endoscopy screening in patients previously treated for head and neck squamous-cell carcinoma. Ann Oncol 2001; 12: 643-646
    CrossrefPubMedGoogle Scholar
  • 16 Dubuc J, Legoux J, Winnock M. et al. Endoscopic screening for esophageal squamous-cell carcinoma in high-risk patients: a prospective study conducted in 62 French endoscopy centers. Endoscopy 2006; 38: 690-695
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Boller D, Spieler P, Schoenegg R. et al. Lugol chromoendoscopy combined with brush cytology in patients at risk for esophageal squamous cell carcinoma. Surg Endosc 2009; 23: 2748-2754
    CrossrefPubMedGoogle Scholar
  • 18 Salcedo-bellido I, Requena P, Mateos R. et al. Factors associated with the development of second primary tumours in head and neck cancer patients. Eur J Cancer Care 2022; 31: e13699
    CrossrefPubMedGoogle Scholar
  • 19 National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much. A clinician’s guide. 2007 Available at (Accessed 06/22/2023): https://pubs.niaaa.nih.gov/publications/clinicianGuide/guide/intro/data/resources/Clinicians%20Guide.pdf
    PubMedGoogle Scholar
  • 20 Adjei Boakye E, Buchanan P, Hinyard L. et al. Risk and outcomes for second primary human papillomavirus-related and -unrelated head and neck malignancy. Laryngoscope 2019; 129: 1828-1835
    CrossrefPubMedGoogle Scholar
  • 21 Leemans CR, Smeele LE, Langendijk JA. et al. Guideline head and neck cancer (in Dutch: richtlijn Hoofd-halstumoren) 2012. Available at (Accessed 06/22/2023): https://richtlijnendatabase.nl/richtlijn/hoofd-halstumoren/hoofd-halstumoren_-_korte_beschrijving.html
    PubMedGoogle Scholar
  • 22 Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (Suppl. 06) S3-43
    CrossrefPubMedGoogle Scholar
  • 23 Kondo N, Tsukuda M, Nishimura G. Diagnostic sensitivity of (1)(8)fluorodeoxyglucose positron emission tomography for detecting synchronous multiple primary cancers in head and neck cancer patients. Eur Arch Otorhinolaryngol 2012; 269: 1503-1507
    CrossrefPubMedGoogle Scholar
  • 24 Su H-A, Hsiao S-W, Hsu Y-C. et al. Superiority of NBI endoscopy to PET/CT scan in detecting esophageal cancer among head and neck cancer patients: a retrospective cohort analysis. BMC cancer 2020; 20: 1-9
    PubMedGoogle Scholar
  • 25 IKNL – Netherlands Comprehensive Cancer Organisation. Netherlands cancer registry. Available at (Accessed 06/22/2023): https://iknl.nl/nkr-cijfers
    PubMedGoogle Scholar
  • 26 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022. Endoscopy 2022; 54: 591-622
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 van Tilburg L, van den Ban SA, van de Ven SEM. et al. Screening for head and neck tumors in patients with esophageal squamous cell carcinoma and vice versa: a nationwide survey among medical specialists. Endosc Int Open 2022; 10: E1268-E74
    Article in Thieme ConnectPubMedGoogle Scholar