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The high incidence of multiple primary carcinomas occurring in the upper aerodigestive tract is well documented, with the accepted incidence being as high as 20-30%. The full clinical significance of this phenomenon is, however, only now becoming apparent. Herein 548 cases of documented multiple primary neoplasms, presenting initially in the upper aerodigestive tract, are evaluated retrospectively to establish the survival in these patients. The overall 5 year survival rate after diagnosis of the second neoplasm was found to be 22.3% which was significantly lower than a control group.

The reasons for this poor survival are considered. These include: 1. the high incidence of second cancers developing in the lung and esophagus which have an extremely poor survival rate; 2. the frequent late diagnosis of the second lesions, with resultant advanced staging, and therefore poor prognosis; 3. inability to institute the appropriate therapy for these lesions due to the effects of previous radical therapy utilized for the first tumor.

The clinical implications of this problem are discussed.

(C) The American Laryngological, Rhinological & Otological Society, Inc.