Long-Term Survival in Metachronous Primary Malignancies: Stage III Nasopharyngeal Cancer and Stage IV Non-Small-Cell Lung Cancer

Abstract

Introduction: The occurrence of a second primary lung cancer after head and neck cancer is a challenge for multidisciplinary teams, since the development of a second lung cancer negatively affects the survival rate of patients with head and neck cancer. Case Presentation: This article presents the case of a patient with a double location of cancer: inoperable stage III nasopharyngeal carcinoma, biopsied in December 2017 (non-keratinizing nasopharyngeal carcinoma), treated by means of radiotherapy and chemotherapy (2018-2021), and stage IV lung cancer (squamous carcinoma) with lung metastases, diagnosed in December 2021, treated using polychemotherapy, subsequent maintenance monochemotherapy, radiotherapy of the thorax, and subsequent maintenance monochemotherapy with a favorable result. The patient was still under treatment as of February 2025, the date of the preparation of the current article. Discussion and Literature Review: Regarding the location of the second metachronous cancer, studies show that the most frequent locations are the lungs and the esophagus, with the main causes being alcohol consumption and smoking. Therefore, these patients should be monitored by screening the respiratory and digestive tracts, especially in men, in order to identify a second cancer, either synchronous or metachronous, in an early stage. Conclusions: Educating the patient with head and neck cancer regarding quitting smoking and cutting out alcohol, as well as conducting a follow-up survey, may reduce the incidence of multiple primaries. Moreover, the multidisciplinary management of second primary lung malignancies in patients with head and neck cancer may lead to long-term disease monitoring.

Keywords: favorable response; long-term survival; lung cancer; metachronous primary cancers; nasopharynx.

Figure 1

MRI of the cranio-cerebral area with contrast medium in November 2017. The infiltrating tumor mass affects the cavity on the right side, with extension at the base of the cranium (yellow arrow).

Figure 2

The computed tomography of the cervical area with contrast medium—October 2019. The nasopharyngeal tumor with osteolysis at the base of the cranium (yellow arrow), with extension of 30/20/15 mm.

Figure 3

The CT scan of the cervical area with contrast medium—October 2021. Moderate diffuse thickening of the mucosa of the cavity of 5 mm (yellow arrow).

Figure 4

The CT scan of the thorax with contrast medium—October 2021. A few newly occurring micronodules and small pulmonary nodules (black arrows) appeared in the right Fowler segment, respectively, of the upper lingula (9/7 mm).

Figure 5

PET-CT scan—June 2022. Dimensional regression of the bilateral micronodular and nodular lesions, with a current maximum of 3 mm (yellow arrow).

Figure 6

CT scan of the cervical region—December 2024. The focal lysis was maintained in the cavum (yellow arrow). No submandibular or latero-cervical lymphadenopathies.

Figure 7

CT scan of the thorax—December 2024. No newly occurring or evolutionary pleuro-pulmonary nodular lesions.