Evaluation of Optimal Assessment Schedules for Surveillance After Definitive Locoregional Treatment of Locally Advanced Head and Neck Cancer

Abstract

ImportanceIn clinical practice, assessment schedules are often arbitrarily determined after definitive treatment of head and neck cancer (HNC), producing heterogeneous and inconsistent surveillance plans.ObjectiveTo establish an optimal assessment schedule for patients with definitively treated locally advanced HNC, stratified by the primary subsite and HPV status, using a parametric model of standardized event-free survival curves.Design, Setting, and ParticipantsThis was a retrospective study including 2 tertiary referral hospitals and a total of 673 patients with definitive locoregional treatment of locally advanced HNC (227 patients with nasopharyngeal cancer [NPC]; 237 patients with human papillomavirus-positive oropharyngeal cancer [HPV+ OPC]; 47 patients with HPV-negative [HPV−] OPC; 65 patients with hypopharyngeal cancer [HPC]; and 97 patients with laryngeal cancer [LC]). Patients had received primary treatment in 2008 through 2019. The median (range) follow-up duration was 57.8 (6.4-158.1) months. Data analyses were performed from April to October 2021.Main Outcomes and MeasuresTumor recurrence and secondary malignant neoplasms. Event-free survival was defined as the period from the end of treatment to occurrence of any event. Event-free survival curves were estimated using a piecewise exponential model and divided into 3 phases of regular follow-up. A 5% event rate criterion determined optimal follow-up time point and interval.ResultsThe median (range) age of the 673 patients at HNC diagnosis was 58 (15-83) years; 555 (82.5%) were men; race and ethnicity were not considered. The event rates of NPC, HPV+ OPC, HPV− OPC, HPC, and LC were 18.9% (43 of 227), 14.8% (35 of 237), 36.2% (17 of 47), 44.6% (29 of 65), and 30.9% (30 of 97), respectively. Parametric modeling demonstrated optimal follow-up intervals for HPC, LC, and NPC, respectively, every 2.1, 3.2, and 6.1 months; 3.7, 5.6, and 10.8 months; and 9.1, 13.8, and 26.5 months until 16.5, 16.5 to 25.0, and 25.0 to 99.0 months posttreatment (open follow-up thereafter). For HPV− OPC, assessment was recommended every 2.7, 4.8, and 11.8 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. In contrast, HPV+ OPC optimal intervals were every 7.7, 13.7, and 33.7 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. Five, 4, 12, 15, and 10 follow-up visits were recommended for NPC, HPV+ OPC, HPV− OPC, HPC, and LC, respectively.Conclusions and RelevanceThis retrospective cohort study using parametric modeling suggests that the HNC assessment schedules should be patient tailored and evidence based to consider primary subsites and HPV status. Given limited health care resources and rising detection rates and costs of HNC, the guidelines offered by these findings could benefit patients and health systems and aid in developing future consensus guidelines.

Predicting specific mortality from laryngeal cancer based on competing risk model: a retrospective analysis based on the SEER database

“…For example, in South America, >60% of throat cancer patients are associated with smoking and drinking habits (6,9,10). In addition, recent studies have detected human papillomavirus (HPV) infection in approximately 20-30% of laryngeal cancer patients and may be associated with survival in laryngeal cancer patients (11)(12)(13).…”

Determining the Right Surveillance Regimen for Survivors of Locoregionally Advanced Head and Neck Cancer—How Much Is Too Much?

“…Based on this model, optimal follow-up schedules varied widely. 2 For HPV + oropharyngeal carcinoma, follow-up was recommended every 7.1 months in the first phase and even less often in later phases, whereas for hypopharyngeal carcinoma, follow-up was recommended every 2.1 months in the first phase and continued being quite intensive in the later phases. Overall, survivors of HPV + oropharyngeal cancer required only 4 additional surveillance visits during 8 years after the initial 6-month posttreatment period, whereas survivors of hypopharyngeal cancer required 15 visits.…”

“…These limitations aside, parametric piecewise exponential modeling has shown promise (as the authors noted) for glioma surveillance 2 ; other studies have shown its potential for use in studying breast cancer and melanoma outcomes. 3,4 However, to our knowledge, no study has validated parametric modeling in head and neck cancer.…”

“…In this issue of JAMA Otolaryngology—Head & Neck Surgery , Dr Lee and colleagues have addressed optimal surveillance visit schedules for patients who have survived head and neck cancer. The authors retrospectively analyzed events (recurrence and second primary cancers) of 673 patients during 11 years at 2 tertiary medical centers.…”

“…Based on this model, optimal follow-up schedules varied widely . For HPV + oropharyngeal carcinoma, follow-up was recommended every 7.1 months in the first phase and even less often in later phases, whereas for hypopharyngeal carcinoma, follow-up was recommended every 2.1 months in the first phase and continued being quite intensive in the later phases.…”