OBJECTIVE: Determine whether survival for second

primary head and neck cancer is truly poorer than survival for first primaries. METHODS: From the Surveillance, Epidemiology and End Results database, 2 cohorts were constructed. One cohort consisted of patients with exactly 1 head and neck primary malignancy; the second cohort consisted of patients with exactly 2 head and neck primaries, restricted to second primaries of the tongue, tonsil, glottic larynx, and hypopharynx with squamous cell carcinoma (SCCA) histology. Demo-graphic and extent of disease data were extracted. For each primary site,matched Kaplan-Meier survival analysis was conducted comparing overall survival between the two cohorts matching for primary site, year of diagnosis, age, gender, and cancer stage. RESULTS: A total of 242 cases of second head neck primary were successfully matched to patients with single primary disease. Among 96 patients with oral tongue SCCA, mean (median) survival was 40.1 (28) months after the second primary diagnosis versus 52.2 (32) months for matched single primary patients (P 0.552, log-rank test). Among 45 tonsillar carcino-mas, mean survival was 42.8 (30) versus 90.9 (NA) months for the second primary and single primary cohorts, respectively (P 0.028). Among 52matched glottic carcinomas, mean survival was 46.4 (27) ver-sus 103.5 (120) months for the 2 cohorts, respectively (P < 0.001). Among 49 hypopharyngeal carcinomas, mean survival was 35.6 (19) versus 53.9 (21) months