PET surveillance for head and neck cancer – pro

Routine surveillance is not indicated and not recommended by any guidelines. As such, it is not supported by credible scientific evidence published in peer-reviewed medical literature generally and recognized by the relevant medical community, such as guidelines cited in the Reference section. It is not clinically appropriate in terms of type, frequency, extent, site and duration and considered effective for the condition in question; AND◦not primarily for the convenience of the patient or health care provider .

Per NCCN on p. FOLL-A, a CT is recommended within 6 months weeks and thereafter imaging is not routinely recommended for symptomatic patients. There are no prospective data demonstrating a survival benefit for any follow-up strategy in patients with treated head and neck cancer and available retrospective data are conflicting.

There are no prospective data demonstrating a survival benefit for any follow-up strategy in patients with treated head and neck cancer and available retrospective data are conflicting. Routine surveillance has been associated with a survival benefit in some observational studies when patients diagnosed at routine follow-up were compared with those who presented with symptoms . However, other studies have not observed a survival benefit from detecting asymptomatic recurrences. This may be because most recurrences are symptomatic early on or because early diagnosis does not appreciably benefit recurrent patients.

Posttreatment surveillance may be most effective in patients who initially have limited disease and who thus retain an option for future curative therapy, such as those with T1 and T2 tumors who received single modality surgery or radiation therapy. Those seem to be the patients who benefit from surveillance in some studies. Despite sureillance survival remains poor for patients who were previously treated for advanced stage disease or who initially presented with regional disease. A this time, there are no guidelines that recommend surveillance for any type of head and neck cancer.

The detection of residual disease after therapy is a particularly difficult problem for patients who have head and neck cancer. Surgery, radiation therapy, and chemotherapy may result in anatomic changes that are difficult to differentiate from recurrent or residual tumor. CT and MRI frequently require serial studies to determine if tumor recurrence is present or absent. FDG-PET is not based on anatomic information, so the functional imaging of PET is able to provide an accurate determination of residual disease after therapy. Several studies have demonstrated the sensitivity of PET in the detection of recurrent or residual disease to be 81% to 100%, and the specificity to be 61% to 100%. The lower specificity results from the false-positive studies that occur with inflammatory lesions after radiation therapy, which may persist for up to 4 months after completion of therapy., Head and Neck, Oral Cavity, 2012

Francesca De FeliceDaniela Musio, and Vincenzo Tombolini Follow-Up in Head and Neck Cancer: A Management Dilemma Advances in Otolaryngology
Volume 2015 (2015), Article ID 703450.

Ritoe SC, de Vegt F, Scheike IM, et al. Effect of routine follow-up after treatment for laryngeal cancer on life expectancy and mortality: results of a Markov model analysis. Cancer 2007; 10, 9:239.

Francis DO, Yueh B, Weymuller EA Jr, Merati AL. Impact of surveillance on survival after laryngeal cancer in the medicare population. Laryngoscope 2009; 119:2337.

Agrawal A, Hammond TH, Young GS, et al. Factors affecting long-term survival in patients with recurrent head and neck cancer may help define the role of post-treatment surveillance. Laryngoscope 2009; 119:2135.

Manikantan K, Khode S, Dwivedi RC, et al. Making sense of post-treatment surveillance in head and neck cancer: when and what of follow-up. Cancer Treat Rev 2009; 35:744.

Joshi A, Calman F, O’Connell M, et al. Current trends in the follow-up of head and neck cancer patients in the UK. Clin Oncol (R Coll Radiol) 2010; 22:114.

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