gms | German Medical Science

Introduction: The incidence of metachrone secondary carcinoma after squamos cell carcinoma of the upper aerodigestiv tract averages 15%. Secondary carcinoma within the nasal cavity and the paranasal sinuses account for only 1%. They are commonly diagnosed at advance stages leading to considerably worse outcome. The pathophysiological alterations after laryngectomy account for the concealed clinical symptoms and display a real challenge in oncological follow up of these patients. In this study we present our clinical experience with metachrone sinunasal carcinoma after laryngectomy in regard to the spare literature on this topic.

Patients and methods: In a retrospective analysis we reviewed the charts of all patients in our department that developed a metachrone sinunasal carcinoma after laryngectomy.

Results: From 2003 to 2008 five patients developed metachrone sinunasal carcinomas 7 months to 38 years after laryngectomy. Epistaxis and facial pain or pressure were the major complaints. Three patients presented with a secondary tumour in the nasal cavity and two patients developed carcinomas of the maxillary sinus. All secondary carcinomas were diagnosed at stage T3 or T4. Only one patient was suitable for curative tumor resection. In one patient R1-resection of the tumour was feasible and three patients were eligible for primary radiochemotherapy. Overall survival after treatment of the second malignancy varied from 6 to 20 months.

Conclusion: Metachrone sinunasal carcinomas are diagnosed at advanced stages. This may be due to occult early clinical symptoms such as nasal obstruction, rhinorrhea oder hyposmia that cannot be sensed by laryngectomized patients. In most cases there are no curative treatment options at the time of diagnosis. Therefore the oncological follow up of patients after laryngectomy should include a thoroughly endoscopic examination of the nasal cavity and the paranasal sinuses even when sinunasal symptoms are not present.