Surveillance of Patients with Head and Neck Cancer with an Intensive Clinical and Radiologic Follow-up
Martina Imbimbo, MD, Salvatore Alfieri, MD, Laura Botta, MSc, Cristiana Bergamini, MD, Annunziata Gloghini, PhD, Giuseppina Calareso, MD, Ester Orlandi, MD, Nicola Alessandro Iacovelli, MD, Marco Guzzo, MD, Roberta Granata, MD, Carlo Resteghini, MD, Laura Locati, MD, Chiara Costanza Volpi, PhD, Lisa Licitra, MD, Paolo Bossi, MD
https://doi.org/10.1177/0194599819860808 | First Published July 9, 2019
Abstract
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Objective
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.

Study Design
Retrospective analysis.

Setting
Single academic tertiary care center.

Subjects and Methods
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.

Results
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).

Conclusions
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.