Post-treatment surveillance imaging in head and neck cancer: a systematic review

Abstract

Background In patients treated for head and neck cancer, imaging studies are usually obtained within 3–6 months after treatment for assessment of treatment response. After 6 months, most guidelines advocate clinical follow-up, with imaging reserved for patients with clinically suspect or equivocal findings. However, some guidelines do recommend systematic imaging surveillance, and many clinicians tend to include some type of imaging in their follow-up schemes. Objectives This systematic review focuses on the usefulness of routine (systematic) post-treatment imaging surveillance of head and neck cancer beyond the first 3–6-month baseline imaging study. Methods A systematic literature search was conducted using PubMed and Google Scholar. Additional studies were identified by reviewing reference lists. Only original studies and review papers were considered. Results obtained with systematic post-treatment surveillance imaging were compared to symptom-directed imaging and/or clinical finding-directed imaging. Results Five hundred twenty-one records were identified through the database search, and 44 additional records were identified through other sources. Forty-eight articles were selected for the final review. Analysis of these records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging (40.9%), and the mean time of detection of recurrent or metastatic disease (11.5 months) was well beyond the period of the first post-treatment scan. Most authors reported superior results with PET-CT when compared to other imaging techniques. Conclusion Strong arguments were found in favor of systematic imaging surveillance in locoregional advanced head and neck cancer during at least one and preferably 2 years after treatment. Critical relevance statement Analysis of the selected records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging. This systematic review suggests that imaging may currently be underused in the post-treatment surveillance of patients with head and neck cancer. Key points • This systematic review focuses on the usefulness of long-term systematic imaging surveillance in patients treated for head and neck cancer. • Analysis of 521 articles revealed that systematic imaging allowed the initial detection of locoregional recurrences and/or metastases in more than 40% of patients. • Imaging may currently be underused in the post-treatment surveillance of patients with advanced head and neck cancer. Graphical Abstract

Predicting Response to Exclusive Combined Radio-Chemotherapy in Naso-Oropharyngeal Cancer: The Role of Texture Analysis

“…The low number of patients overall-and specifically of positives after RT-CHT treatment-is derived from the fact that the study dataset was collected as homogeneously as possible to reduce possible biases resulting from differences among patients enrolled. Secondly, as we know, HPV-and EBV-positive oropharyngeal and nasopharyngeal cancers tend to show a high response rate to medical therapy [24], and, therefore, it is difficult to study the recurrence of disease due to the-fortunately-relatively small number of patients. To this end, a decision was made to jointly study nasopharyngeal and oropharyngeal tumors, despite the different etiopathogenesis.…”

“…This was further highlighted in the eighth UICC/AJCC staging system, where two different TNM staging systems are proposed depending on the expression of p16 [20,21]. Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET-CT) are used for the staging and follow-up of head and neck tumors; ultrasound is used when latero-cervical lymph node metastases need to be assessed [22][23][24]. Among these, MRI is the most suitable exam for better visualizing soft tissues, as well as performing a multiparametric evaluation of lesions, thanks to the use of dynamic contrast-enhanced perfusion imaging (DCE-PWI) and diffusion weighted imaging (DWI) [25][26][27].…”