Surveillance of Patients with Head and Neck Cancer with an Intensive Clinical and Radiologic Follow-up

• Published in: Otolaryngology-head and neck surgery Vol. 161; no. 4; p. 635
• Main Authors: Imbimbo, Martina, Alfieri, Salvatore, Botta, Laura, Bergamini, Cristiana, Gloghini, Annunziata, Calareso, Giuseppina, Orlandi, Ester, Iacovelli, Nicola Alessandro, Guzzo, Marco, Granata, Roberta, Resteghini, Carlo, Locati, Laura, Volpi, Chiara Costanza, Licitra, Lisa, Bossi, Paolo
• Format: Journal Article
• Language: English
• Published: England 01.10.2019
• Subjects: Academic Medical Centers; Adult; Aftercare; Aged; Aged, 80 and over; Combined Modality Therapy; Female; Head and Neck Neoplasms - diagnostic imaging; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - therapy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - therapy; Neoplasms, Second Primary - therapy; Population Surveillance; Positron-Emission Tomography; Retrospective Studies; Salvage Therapy; Survival Analysis; Tomography, X-Ray Computed; Young Adult; recurrence; follow-up; surveillance; head and neck cancer; secondary primary cancer
• ISSN: 1097-6817
• DOI: 10.1177/0194599819860808

There is no consensus on the follow-up modalities in patients with head and neck cancer. This study aims to describe the pattern and survival outcomes of recurrences/second primary cancers in patients undergoing an intensive radiologic and clinical follow-up. Retrospective analysis. Single academic tertiary care center. All patients with stage III-IV head and neck cancer treated with chemoradiotherapy at our institution between 1998 and 2010 were retrospectively reviewed. Persistent/recurrent disease within 6 months since the curative treatment and second primary cancers outside the upper aerodigestive tract were excluded. Data were analyzed by descriptive statistics. Surveillance was planned every 3 months in the first year, then with increasing intervals till the fifth year. A total of 326 patients were included. Out of all detected cancer recurrences (n = 106, 32%), 38 (36%) were locoregional, 44 (41%) were distant, and 24 (23%) were second primary cancers. Approximately 70% of recurrences were clinically and/or radiologically discovered, while 30% were diagnosed due to the patients' symptoms. Of all clinically and/or radiologically discovered recurrences/second primary cancers (n = 74), 26 (35%) were curatively treated, with respect to 9 of the 32 (28%) diagnosed by symptoms. Median overall survival of recurrent curable cases did not significantly differ according to the detection modality (89 months by clinical/radiologic examination vs 85 by symptoms). Clinical and radiologic follow-up identified more recurrences/second primary cancers than the symptom-driven monitoring, but the curability of cancer recurrence was similar regardless of detection modality. Prospective trials are needed to define the most effective follow-up strategy in head and neck cancer.