Is there a benefit of adding surveillance imaging to frequent history and physical exams in patients treated definitively for head and neck squamous cell carcinoma?

• Published in: Journal of clinical oncology Vol. 37; no. 15_suppl; p. 6074
• Main Authors: Chi, Jeffrey, Sugarman, Ryan, Lee, Matthew C., Kamdar, Dev, Frank, Douglas K., Pereira, Lucio, Gabalski, Edward Z., Goncalves, Priscila Hermont, Parashar, Bhupesh, Teckie, Sewit, Ghaly, Maged, Seetharamu, Nagashree
• Format: Journal Article
• Language: English
• Published: 20.05.2019
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2019.37.15_suppl.6074

Abstract only 6074 Background: In head and neck squamous cell carcinoma (HNSCC) patients (pts) who completed curative-intent definitive treatment (tx), close surveillance is important. Across all centers, pts are closely monitored for symptoms and undergo frequent dedicated head and neck evaluation. Role of surveillance imaging after the initial 12 week post-treatment PET/CT however is less clear. Our institutional practice is to follow pts with regular interval imaging for two years after treatment. However this carries a financial cost, and risk for false positives and unnecessary biopsies. Methods: This is a retrospective chart review of pts treated definitively for HNSCC at our institution from 2012 to 2016. Pts who had a biopsy (bx) post-tx due to suspicion for recurrence were included. Pts belonged to 3 groups: In the first group (A), biopsy was prompted by findings on surveillance imaging (SI); in the second (B), biopsy was prompted by symptom triggered imaging (STI) and in the third (C), biopsy was based on physical exam (PE). We recorded the aggregate results of bx in each group and calculated the positive predictive value (PPV) for each. Results: Of 353 HNSCC pts, 66 underwent post-tx bx for suspected recurrence of which 46 were positive. Of the 30 pts in group A, 21 had positive bx (PPV = 70%). Within this group, PPV was highest with PET/CT (81.82%) followed by magnetic resonance imaging (66.67%) and CT (62.5%). 20 out of 20 pts in group B had bx-proven recurrence (PPV = 100%). 27 out of 36 pts in group C had positive bx (PPV = 75%). While there was no overlap between groups A and B, there was some overlap between groups A and C; and B and C. 45.45% of all recurrences were captured because of SI. When both imaging and PE conducted were positive simultaneously, 54.35% of recurrences were detected first by PE and 45.65% by imaging. Conclusions: Bx triggered by STI has the highest PPV. SI has the lowest PPV, but 45.65% of recurrences were diagnosed because of SI alone. Our study suggests that routine SI for at least two years post treatment for HNSCC patients may add to the surveillance value of frequent PE but larger studies are needed to determine the optimal frequency and type of SI modality.