Second Primary Cancer After Radiotherapy for Nasopharyngeal Carcinoma

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07/12/23

James CHOW
Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong

Second primary cancer (SPC) is one of the leading causes of late mortality in patients with head and neck cancers. Nasopharyngeal carcinoma represents a distinct disease entity characterized by favorable prognosis and the exclusive use of radiotherapy as its mainstay treatment modality. Early risk prediction models have raised concerns about a theoretically greater risk of radiation-associated malignancy with modern intensity-modulated radiotherapy (IMRT) due to its large integral dose and collimator leakage. Recent data have suggested a 1.9 fold higher cancer risk in post-IMRT NPC survivors than the general population. Significant excess cancer risks were observed for oral cavity, sarcoma, oropharynx, paranasal sinus, salivary gland, thyroid, skin and lung. Close surveillance of NPC survivors for SPC, especially young patients who have passed the mark of 10 years of cure, is warranted as part of long-term survivorship care.