Double primary malignancies in head-and-neck cancer: Clinicodemographic profile, treatment patterns, and outcomes – A retrospective analysis from a tertiary cancer center

Abstract: BACKGROUND: Double primary malignancies (DPMs) in the head-and-neck region represent a distinct and challenging clinical entity. This study describes the clinicodemographic profile, treatment patterns, and outcomes of patients presenting with DPMs at a tertiary cancer center. MATERIALS AND METHODS: This is a retrospective study of 59 patients with histopathologically confirmed DPM diagnosed and treated between 2011 and 2024. Demographic data, tumor characteristics, treatment modalities, response rates, toxicities, and survival outcomes were analyzed. The Warren and Gates criteria were used to define DPMs. RESULTS: The cohort comprised 59 patients with a median age of 58 years (range: 36–85). Males predominated (81.4%). Tobacco use (smoking 40.7%, chewing 37.3%) and alcohol consumption (44.1%) were prevalent. Synchronous primaries were identified in 54 (91.5%) patients and metachronous in 5 (8.5%). The oral cavity (49.2%) and oropharynx (32.2%) were the most common first primary sites, while the esophagus (23.7%) and hypopharynx (22.0%) were the most frequent second primary sites. The most common site combination was oropharynx + esophagus ( n = 10, 16.9%). The majority of patients had advanced stage disease at first primary (stage IVA: 52.5%). Concurrent chemoradiation (CTRT) was the most common treatment modality (62.7%). Complete response was achieved in 47.3% of evaluable patients. Grade II mucositis was the most common acute toxicity (18.6%). The median overall survival was 22 months. CONCLUSIONS: Early detection through systematic endoscopic screening and a standardized multidisciplinary approach are essential to improve outcomes in this complex population.