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

Abstract

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.

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

“…8,15,30 Schwartz et al 15 reported that 86% of recurrent disease was detected clinically, and no survival benefit was found in those who had the disease detected by imaging alone. This model provides a potential framework to establish a more cost-effective and time-effective surveillance program.…”

“…8 Although the data used in this model were Cancer February 15, 2020 based on a single-institution data set, they included follow-up data on >1500 patients with a median follow-up of 99 months-allowing the model to make assumptions as "real-life" as possible. 8 Although the data used in this model were Cancer February 15, 2020 based on a single-institution data set, they included follow-up data on >1500 patients with a median follow-up of 99 months-allowing the model to make assumptions as "real-life" as possible.…”

“…8 The majority (82%) had oropharyngeal cancer, and 63% were never smokers or former light smokers (less than ten pack years). 8 The majority (82%) had oropharyngeal cancer, and 63% were never smokers or former light smokers (less than ten pack years).…”

“…8 Patients' demographics, tumor and treatment characteristics, frequency of surveillance imaging and modality, and disease recurrence details were provided. We consider both finite and infinite horizon models.…”

“…An institutional data set of patients with mucosal HNC who were treated with radiotherapy was used in this model. 8 Patients' demographics, tumor and treatment characteristics, frequency of surveillance imaging and modality, and disease recurrence details were provided.…”