The dilemma of follow-up in head and neck cancer patients

Abstract

The aims of tumor follow-up in head and neck cancer patients are (1) evaluation of therapeutic efficacy, (2) management of impairments, (3) detection of new tumor manifestations, and (4) psychosocial care. In general standardized 5-year-protocols are used for all such patients. However, it is questionable whether a rigid follow-up schedule is optimal for a very heterogeneous tumor population. Therefore 603 patients with sqamous cell carcinoma of the oral cavity, pharynx or larynx, or with cervical metastasis from an unknown primary site (CUP syndrome), who had been diagnosed and treated curatively by an operation with or without radiotherapy (n = 523) or just by radio(chemo)therapy (n = 80) between 1985 and 1994, and who had been followed-up regularly according to a standardized plan, were worked-up retrospectively. Data were evaluated for the manifestation and prognosis of curable new tumor manifestations as well as for tumor-specific factors likely to select groups which should be followed more or less intensively. Within a 5-year follow-up period new tumor growth was detected in 152/603 (25%) patients: 79 local and 31 regional recurrences, 18 systemic metastases and 24 second primary cancers. Where follow-up was extended beyond the 5th year, 168/603 (28%) patients presented a new tumor manifestation. One hundred and sixteen of the 152 (28%) patients had another operation with or without radiotherapy or had radio(chemo)therapy alone. So far 18/116 (14%) patients have survived their new tumor manifestation for more than 5 years and 30/116 for more than 2 years. Tumor-specific data on the initial tumors (T stage, N stage, site) did not indicate the risk of a new tumor manifestation, but 87% of patients who survived their new tumor manifestation for more than 2 years initially had T1 or T2 tumors and only 30% initially had N+ necks. Occurrence of distant metastasis or a second primary outside the head and neck region limited survival to < or = 2 years after detection. In terms of survival, follow-up efforts should therefore concentrate on detection of locoregional recurrence, particularly if an option for further curative local therapy exists. The limited success of detection of new tumor manifestations in terms of survival does not justify a reduction in tumor-follow-up examinations, since the benefit of the other efforts cannot be determined from survival figures.

Does 18F-FDG PET/CT Improve the Detection of Posttreatment Recurrence of Head and Neck Squamous Cell Carcinoma in Patients Negative for Disease on Clinical Follow-up?

“…The usual follow-up consists of periodic standard examinations of the head and neck during the 5 y after treatment, including inspection and palpation of all anatomic subsites of the head and neck (oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx) and examination of internal structures by a mirror and a flexible endoscope (4). 18 F-FDG PET may be an effective technique for the detection of residual tumor recurrence and distant metastases after treatment.…”

Variation in Routine Follow-Up Care After Curative Treatment for Head-and-Neck Cancer: A Population-Based Study in Ontario

“…The literature pertaining to how follow-up care can most effectively manage morbidity and address other health needs in head-and-neck cancer patients is limited 12,13 . Consequently, guidelines-from the British Association of Head and Neck Oncologists 14 , the American Head and Neck Society 15 , the U.S. National Comprehensive Cancer Network (nccn) 16 , the American Cancer Society 17 , Cancer Care Ontario 18 , and the BC Cancer Agency 19 -are based on consensus only and vary with the organization (Tables i and ii).…”

Avaliação da sobrevida livre de doença de pacientes com recidiva loco-regional de carcinoma epidermóide de cavidade bucal e orofaringe submetidos a tratamento de resgate

“…Segundo Cooney et al, 12 observaram bons resultados do resgate cirúrgico em somente 5% em cinco anos, com sobrevida média livre de doença de seis meses. Em contrapartida, encontram-se índices de sucesso de 26% nas cirurgias de resgates em cinco anos, sendo a maioria dos casos detectados em estádios precoces da doença, na ocasião da recidiva 13 . Embora os resultados do tratamento de resgate, seja cirúrgico, radioterápico ou associação de cirurgia e radioterapia no pós-operató-rio sejam pobres, em alguns casos, as perspectivas desfavoráveis de controle da doença são superadas.…”