Clinical Evidence of Methods and Timing of Proper Follow-Up for Head and Neck Cancers

• Published in: Onco Vol. 4; no. 4; pp. 275 - 286
• Main Authors: Gili, Riccardo, Caprioli, Simone, Lovino Camerino, Paola, Sacco, Gianluca, Ruelle, Tommaso, Filippini, Daria Maria, Pamparino, Silvia, Vecchio, Stefania, Marchi, Filippo, Del Mastro, Lucia, Cittadini, Giuseppe
• Format: Journal Article
• Language: English
• Published: 29.09.2024
• ISSN: 2673-7523; 2673-7523
• DOI: 10.3390/onco4040020

Background: For patients with head and neck squamous cell carcinoma (HNSCC), after a single or multi-modality treatment, a specific follow-up strategy is needed, but there is no agreement between the main international societies on the proper methods and timing of follow-up. Methods: We performed a descriptive review to evaluate the available data and compare the main guidelines, giving some practical guidance to perform effective personalized follow-up strategies. Results and Conclusions: While clinical and endoscopic follow-up alone seems to be appropriate for early-stage HNSCCs, the addition of close radiologic follow-up in locally advanced HNSCCs is still debated, as there are no data indicating that an earlier detection of recurrence correlates with increased survival, while it is mandatory in the first three-six months to define the response to treatment. For patients who have undergone conservative surgery or have major pathological risk factors, the incidence of locoregional recurrence is higher, and locoregional radiologic follow-up (magnetic resonance imaging is preferred to computed tomography) should be considered. Positron emission tomography may be useful in cases of suspected locoregional persistence of disease, differentiating it from post-irradiation outcomes. Distant radiological follow-up can be considered in the detection of the second primary in cases of specific risk factors and for virus-related tumors. For the latter, the use of circulating DNA should always be considered. A brain scan is not recommended without specific symptoms. For all patients who do not fall into the above categories, clinical and endoscopic follow-up should be proposed, reserving radiological investigations only at the onset of symptoms.