Efficacy of intense screening and treatment for synchronous second primary cancers in patients with esophageal cancer

Background: The optimum management of esophageal cancers with synchronous second primary cancer (SPC) has not been determined. The aim of this study was to evaluate the efficacy of intense screening and treatment for esophageal cancers with synchronous SPC. Methods: Between 1981 and 1997, 1479 patients with esophageal cancers were screened for synchronous SPC during the process of initial staging. Radical treatment was recommended for esophageal cancer and synchronous SPC in cases for whom both cancers were curable. Treatment results for esophageal cancer patients with or without synchronous SPC were compared. Results: Among 1479 patients, 155 (10.5%) were found to have 166 synchronous SPC. Primary sites included the stomach in 65, the head and neck in 44, the colon/rectum in 27, the lung in 14 and other sites in 16 patients. Clinical stages of synchronous SPC were stage I in 41%, stage 11 in 20%, stage III in 25% and stage IV in 14%. The 5-year overall survival rates by clinical stages of esophageal cancers (stage 0, 1, 11, 111, IV) in patients with synchronous SPC were 51% (95% Cl, 23-78%),43% (95% Cl, 18-68%),11% (95% Cl, 0-22%),14% (95% Cl, 0-28%) and 12% (95% Cl, 1-22%), respectively. The 5-year overall survival rate for patients with or without synchronous SPC were 20% (95% Cl, 13-28%) and 32% (95% Cl, 29-35%), respectively. No significant difference was observed between both groups (p = 0.2562). Conclusions: Intense screening and treatment may be justifiable in the light of the high detection rate of curable SPC and the reasonable survival of patients with synchronous SPC. However, a prospective study including cost-benefit analysis is needed to provide the evidence to justify the intense screening and treatment.