545 Second malignancies (SM) in esophageal cancer (EC) after combined modality treatment: Implications for follow-up and chemoprevention

From 5/85 to 12/92, 101 consecutive patients (median age: 61 yrs), with locally advanced EC received a combined chemoradiotherapy treatment, Sixty-one pts were treated with FU + CDDP × 4 cycles and concurrent RT (50 Gy) and 40 pts with 2 courses of the same regimen plus concurrent RT (30 Gy) followed by surgery. Overall survival (OS) at 6 yrs was 22%. In 14 pts EC developed after a previous neoplasm and they were excluded from the analysis. In the remaining 87 pts with primary EC (OS 23% with a median follow up of 77 mos) a total of 12 pts (median age 67 yrs, range 49–79) developed a SM after a median of 27.5 mos (range 7–83) from the diagnosis of EC: 4 epidermoid head and neck cancers, 3 gastric adenocarcinomas (1 early gastric cancer), 1 distal esophageal adenocarcinoma, 2 non small cell lung cancers, 1 colon adenocarcinoma, and 1 vaginal squamous cell carcinoma. Actuarial cumulative risk for SM at 2, 4, and 6 yrs is 6%, 17%, and 23% respectively. Total incidence rate was 6% with an age-adjusted incidence of SM 3 times higher than that of primary cancer in the general population. The high incidence of SM in long-term survivors with EC strongly supports a prolonged follow-up oriented to the early detection of SM. This population with high rate of SM should represent an optimal model to assess the role of chemoprevention.