Safety and cost analysis of an 18FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation

Shah, Kinnari; Marvelde, Luc te; Collins, Marnie; Lourenço, Richard De Abreu; D’Costa, Ieta; Coleman, Andrew; Fua, Tsien; Liu, Chen; Rischin, Danny; Lau, Eddie; Corry, June

doi:10.1016/j.oraloncology.2015.02.005

Cited by 20 publications

(17 citation statements)

References 22 publications

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“…20,21,[23][24][25][26] Therefore, PET imaging potentially can be used as a modality to further stratify surveillance imaging intensity for patients. Shah et al 29 investigated the safety of stratifying follow-up intensity according to PET response after treatment and found that those with negative posttreatment PET imaging results can be safely followed every 6 months rather than every 3 months, with no difference in overall survival or time to the detection of recurrence. Because the cohort in our data set was treated between the years 2000 and 2010, before PET imaging was widely used as a primary modality for posttreatment assessment, we have not factored this into the current model.…”

Section: Discussionmentioning

confidence: 99%

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Ajayi

Schaefer

et al. 2019

Cancer

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BACKGROUND: A possible surveillance model for patients with head and neck cancer (HNC) who received definitive radiotherapy was created using a partially observed Markov decision process. The goal of this model is to guide surveillance imaging policies after definitive radiotherapy. METHODS: The partially observed Markov decision process model was formulated to determine the optimal times to scan patients. Transition probabilities were computed using a data set of 1508 patients with HNC who received definitive radiotherapy between the years 2000 and 2010. Kernel density estimation was used to smooth the sample distributions. The reward function was derived using cost estimates from the literature. Additional model parameters were estimated using either data from the literature or clinical expertise. RESULTS: When considering all forms of relapse, the model showed that the optimal time between scans was longer than the time intervals used in the institutional guidelines. The optimal policy dictates that there should be less time between surveillance scans immediately after treatment compared with years after treatment. Comparable results also held when only locoregional relapses were considered as relapse events in the model. Simulation results for the inclusive relapse cases showed that <15% of patients experienced a relapse over a simulated 36-month surveillance program. CONCLUSIONS: This model suggests that less frequent surveillance scan policies can maintain adequate information on relapse status for patients with HNC treated with radiotherapy. This model could potentially translate into a more cost-effective surveillance program for this group of patients. Cancer 2020;126:749-756.

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Section: Discussionmentioning

confidence: 99%

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Ajayi

Schaefer

et al. 2019

Cancer

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“…The goals of surveillance are to evaluate and manage the late effects of treatment and to detect potentially asymptomatic salvageable recurrences or second primary tumors. More recently, studies have questioned the need for the routine imaging of asymptomatic patients who have achieved complete clinical and radiological response after radiotherapy . The objective of the current study was to assess the efficacy of imaging, in the modern era, compared with clinical evaluation in the detection of early salvageable disease recurrences.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, studies have questioned the need for the routine imaging of asymptomatic patients who have achieved complete clinical and radiological response after radiotherapy. [2][3][4][5][6] Cancer June 1, 2019 The objective of the current study was to assess the efficacy of imaging, in the modern era, compared with clinical evaluation in the detection of early salvageable disease recurrences.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of surveillance imaging in patients with head and neck cancer who are treated with definitive radiotherapy

Pollard

Berends

et al. 2019

Cancer

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Background The current study was performed to assess the efficacy of surveillance imaging in patients with head and neck cancer (HNC) who are treated definitively with radiotherapy. Methods Eligible patients included those with a demonstrable disease‐free interval (≥1 follow‐up imaging procedure without evidence of disease and a subsequent visit/imaging procedure) who underwent treatment of HNC from 2000 through 2010. Results A total of 1508 patients were included. The median overall survival was 99 months, with a median imaging follow‐up period of 59 months. Of the 1508 patients, 190 patients (12.6%) experienced disease recurrence (107 patients had locoregional and 83 had distant disease recurrence). A total of 119 patients (62.6%) in the group with disease recurrence were symptomatic and/or had an adverse clinical finding associated with the recurrence. Approximately 80% of patients with locoregional disease recurrences presented with a clinical finding, whereas 60% of distant disease recurrences were detected by imaging in asymptomatic patients. Despite the earlier detection of disease recurrence via imaging, those patients in the group of patients with clinically detected disease recurrence were significantly more likely to undergo salvage therapy compared with those whose recurrence was detected on imaging (odds ratio, 0.35). There was no difference in overall survival noted between those patients with disease recurrences that were detected clinically or with imaging alone. Approximately 70% of disease recurrences occurred within the first 2 years. In those patients who developed disease recurrence after 2 years, the median time to recurrence was 51 months. After 2 years, the average number of imaging procedures per patient for the detection of a salvageable recurrence for the imaging‐detected group was 1539. Conclusions Surveillance imaging in asymptomatic patients with HNC who are treated definitively with radiotherapy without clinically suspicious findings beyond 2 years has a low yield and a high cost. Physicians ordering these studies must use judicious consideration and discretion.

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“…The recent PET-NECK study has provided high-level evidence that PET-CT–guided surveillance for patients with N2/3 disease is non-inferior to a routine planned neck dissection 15. The strategy of PET-CT-guided surveillance has been shown to be cost-effective 15,23…”

Section: Discussionmentioning

confidence: 99%

Accuracy of [¹⁸Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma

Slevin

Ermiş

Vaidyanathan

et al. 2017

Clin Med Insights Oncol

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INTRODUCTIONThe accuracy of response assessment positron emission tomography (PET)-computed tomography (CT) following radiotherapy with or without chemotherapy for laryngeal/hypopharyngeal squamous cell carcinoma is uncertain.METHODSIn all, 35 patients with laryngeal or hypopharyngeal squamous cell carcinoma who were treated between 2009 and 2014 with (chemo)radiotherapy were identified. The accuracy of response assessment PET-CT was made by correlation with clinical follow-up and pathological findings.RESULTSOf the 35 patients, 20 (57%) had an overall complete metabolic response. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for response assessment [18Fluorine]-fluoro-2-deoxy-d-glucose (FDG) PET-CT for primary and nodal sites, respectively, were 100%, 73%, 46%, and 100% and 83%, 95%, 83%, and 95%.CONCLUSIONSResponse assessment FDG PET-CT following (chemo)radiotherapy for laryngeal and hypopharyngeal carcinomas has a high NPV for both primary site and lymph nodes and can be used to guide treatment decisions. The PPV of residual FDG uptake at the primary tumour site is limited and requires examination and biopsy confirmation.

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Safety and cost analysis of an 18FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation

Cited by 20 publications

References 22 publications

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Usefulness of surveillance imaging in patients with head and neck cancer who are treated with definitive radiotherapy

Accuracy of [¹⁸Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma

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Safety and cost analysis of an 18FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation

Cited by 20 publications

References 22 publications

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Surveillance imaging for patients with head and neck cancer treated with definitive radiotherapy: A partially observed Markov decision process model

Usefulness of surveillance imaging in patients with head and neck cancer who are treated with definitive radiotherapy

Accuracy of [18Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma

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Accuracy of [¹⁸Fluorine]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography-Computed Tomography Response Assessment Following (Chemo)radiotherapy for Locally Advanced Laryngeal/Hypopharyngeal Carcinoma