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The cumulative incidence of second neoplasms in 215 patients with bilateral retinoblastoma was calculated using the life-table method. Second tumors developed in 4.4% of the patients during the first 10 years of follow-up, in 18.3% after 20 years, and in 26.1 % after 30 years. The 30-year cumulative incidence was 35.1 % for the 137 patients who received radiation therapy compared with an incidence rate of 5.8% for the 78 patients who did not receive radiation. In the 137 patients who received radiation, second tumors developed both inside and outside the field of therapy. There was a 30-year incidence rate of second tumors of 29.3% within the field of irradiation and 8.1 % outside the field. The rate outside the field of irradiation (8.1 %) was similar to that observed in nonirradiated patients (5.8%). Our findings indicate that carriers of the retinoblastoma gene have an increased incidence of second tumors, and that the incidence rate is further increased in patients who receive radiation therapy.

Bilateral primary germ cell tumors are uncommon but not rare in men with primary testicular tumors. In our series of 78 cases of germ cell tumors 3 (3.8 per cent) were bilateral. In the management of a second neoplasm the same general principles apply as those for the first tumor but one must be aware of the potential complications of radiation therapy when the total dose for cure of the first and second neoplasms exceeds the tolerance dose of normal tissue and therapy must be modified accordingly. Prognosis is not necessarily poor when a second primary tumor develops and complications can be reduced to a low level with appropriate therapy. Our outline for therapy is presented.

Eight hundred and twenty-five patients with primary carcinomas of the head and neck area were studied. Of these, there were 54 individuals with multiple primary neoplasms. Synchronous lesions occurred in 19 patients while nonsynchronous lesions occurred in 35. The frequency of occurrence of second neoplasms was 6.5%, which nearly doubles that of previously recorded series. A conclusion which can be made from this study is that, as long as the carcinogenic agent (alcohol and/or tobacco) continues to be present, the patient will continue to be affected.

Retinoblastoma is a highly curable tumor unless extraocular extension or metastases have occurred. Intracranial retinoblastoma metastases usually result from either contiguous or hematogenous spread and are rapidly fatal. We report two cases of pathologically proven, hemorrhagic intracranial retinoblastoma metastases and correlate magnetic resonance images with pathologic findings. Magnetic resonance with its high sensitivity and specificity for blood extravasation can document the associated hemorrhagic component of the tumor and help in the differentiation of nonmetastatic second neoplasms in retinoblastoma patients.

The improvement in locoregional control of head and neck carcinomas over the last few decades does not appear to modify the final survival of these patients, mainly due to the appearance of distant metastases and second neoplasms. This article reviews the topic of second neoplasm in patients with an index tumor in the head and neck, making a special point of the incidence and epidemiology of second neoplasms, the influence on prognosis, etiopathogenic theories and the possibility of prevention.

Multicentric neoplastic change must be anticipated when a common tissue presumably endowed with a common susceptibility to t,lalignant disease is exposed to a common carcinogenic influence." (Moertel) 825 patients were followed carefully between 1960 and 1976. Of these, fifty-six were found to develop second primary neoplasms. 61% of these were in the head and neck area and 28% were in the lung and esophagus. This frequency of second neoplasms was 6.5% which nearly doubled that described by Warren and Gates in their large series described in 1932.

Multicentric neoplastic change must be anticipated when a common tissue nresumablv endowed with a common susceptibility to r!!;lJ!‘anant disease is e.x.posed r. -_...._..rl a'.-.‘to a common carcinogenic influence." (Moertel) 8.25 patients were followed carefully between 1960 and 1976. Of these, fifty-six were found to develop second primary neoplasms. 61% of these were in the head and neck area and 28% were in the lung and esophagus. This frequency of second neoplasms was 6.5% which nearly doubled that described by Warren and Gates in their large series described in 1932.