Treatment and survival of second primary early-stage lung cancer, following treatment of head and neck cancer in the Netherlands

• Surveillance for second primary lung cancer (SPLC) is important in head and neck cancer survivorship.
• In early-stage SPLC, both SABR and surgery are potentially curative modalities.
• Distinguishing between early-stage SPLC and a metastasis can be challenging.
• Radical treatment in either situation can be associated with prolonged survival.

ObjectivesThe goal of this study was to evaluate treatment patterns and outcomes in early stage (ES) second primary lung cancer (SPLC) after head and neck squamous cell cancer (HNSCC), in the Netherlands.Methods and materialsDetails of patients diagnosed between 1997 and 2011 with either an ES primary, or a SPLC after HNSCC, were obtained from the Netherlands Cancer Registry. Survival outcomes were compared between treatment groups before, and after, 2005. Univariable and multivariable Cox regression modeling were performed to determine factors prognostic for OS in ES-SPLC.ResultsIn total, 21,648 patients were diagnosed with ES primary (n = 21,032) or SPLC (n = 616). Use of surgery for ES-SPLC decreased significantly over time (range 71–44%, p < 0.001), while the proportion of such patients receiving radiotherapy increased (range 17–41%, p < 0.001). Prior to 2005, OS after surgery in ES-SPLC was significantly better than when compared to radiation, but no difference in OS was noted between surgery and radiotherapy after 2005 (p = 0.116). There were no significant differences in OS between treatment eras for surgery (p = 0.751) and with palliative care (p = 0.306), but a significant improvement in OS was noted for radiotherapy (p = 0.049). Multivariable modeling revealed that age, T-stage, HNSCC location and treatment type were associated with worse OS in the later era.ConclusionChanges in the treatment patterns in HNSCC survivors presenting with ES-SPLC were observed in the Netherlands, with less surgery and increased utilization of radiotherapy. No differences in OS were observed between patients undergoing either surgery or radiotherapy after 2005, suggesting that both local modalities were equally effective.