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

Martina Imbimbo, Salvatore Alfieri, Laura Botta, Cristiana Bergamini, Annunziata Gloghini, Giuseppina Calareso, Ester Orlandi, Nicola Alessandro Iacovelli, Marco Guzzo, Roberta Granata, Carlo Resteghini, Laura Locati, Chiara Costanza Volpi, Lisa Licitra, Paolo Bossi

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Abstract

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.

Original languageEnglish
Pages (from-to)635-642
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume161
Issue number4
DOIs
Publication statusPublished - Oct 1 2019

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Head and Neck Neoplasms
Second Primary Neoplasms
Recurrence
Survival
Chemoradiotherapy
Tertiary Care Centers
Neoplasms
Retrospective Studies

Keywords

  • follow-up
  • head and neck cancer
  • recurrence
  • secondary primary cancer
  • surveillance

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

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title = "Surveillance of Patients with Head and Neck Cancer with an Intensive Clinical and Radiologic Follow-up",
abstract = "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.",
keywords = "follow-up, head and neck cancer, recurrence, secondary primary cancer, surveillance",
author = "Martina Imbimbo and Salvatore Alfieri and Laura Botta and Cristiana Bergamini and Annunziata Gloghini and Giuseppina Calareso and Ester Orlandi and Iacovelli, {Nicola Alessandro} and Marco Guzzo and Roberta Granata and Carlo Resteghini and Laura Locati and Volpi, {Chiara Costanza} and Lisa Licitra and Paolo Bossi",
year = "2019",
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language = "English",
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TY - JOUR

T1 - Surveillance of Patients with Head and Neck Cancer with an Intensive Clinical and Radiologic Follow-up

AU - Imbimbo, Martina

AU - Alfieri, Salvatore

AU - Botta, Laura

AU - Bergamini, Cristiana

AU - Gloghini, Annunziata

AU - Calareso, Giuseppina

AU - Orlandi, Ester

AU - Iacovelli, Nicola Alessandro

AU - Guzzo, Marco

AU - Granata, Roberta

AU - Resteghini, Carlo

AU - Locati, Laura

AU - Volpi, Chiara Costanza

AU - Licitra, Lisa

AU - Bossi, Paolo

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

KW - follow-up

KW - head and neck cancer

KW - recurrence

KW - secondary primary cancer

KW - surveillance

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