Temporal patterns of head and neck squamous cell carcinoma recurrence with positron-emission tomography/computed tomography monitoring

Abstract

Objectives/hypothesis: To estimate the distribution of head and neck squamous cell carcinoma (HNSCC) recurrence after definitive chemoradiation therapy (CRT) among patients who underwent 18F-fluorodeoxyglucose positron-emission tomography and computed tomography (PET/CT) surveillance.

Study design: Retrospective review.

Methods: HNSCC patients who underwent definitive CRT from 2001 to 2008 were evaluated for recurrence with serial PET/CT. Patients were excluded if they were previously treated for recurrent disease, were treated with surgery as the primary therapeutic modality, or had inadequate clinical follow-up. Recurrence was defined by histopathologic evidence of tumor.

Results: Three hundred eighty-eight patients were studied. Patients in whom recurrence was not detected were followed clinically and radiographically for a median of 27 months. Tumor recurrence was detected in 110 patients. For 37 patients, recurrence was heralded by clinical signs. Among the 73 asymptomatic patients who had a confirmed recurrence, disease was detected by PET/CT between 2 and 43 months, median of 6 months. Forty-five percent of observed asymptomatic recurrences were detected during the first 6 months of surveillance (95% confidence interval [CI], 34%-57%), 79% within the first 12 months (95% CI, 68%-88%), 95% within the first 24 months (95% CI, 87%-98%), and 100% within the first 48 months (95% CI, 95%-100%).

Conclusions: Among HNSCC patients followed with PET/CT surveillance, 95% of observed asymptomatic recurrences were detected within 24 months after completing CRT. For patients without clinical signs of recurrence, routine PET/CT surveillance beyond the first 24 months may be of limited value and may not be cost effective.

Fig. 1

Temporal recurrence patterns of 73 head and neck squamous cell carcinoma patients who remained clinically asymptomatic after chemoradiation therapy (CRT) and underwent positronemission tomography/computed tomography surveillance at a single tertiary care center from 2001 to 2010. The recurrence times did not differ by early stage versus late stage (Wilcoxon test, P = .593). Staging information was unavailable for five patients who recurred.

Fig. 2

Cumulative incidence curve demonstrates observed head and neck squamous cell carcinoma recurrence in patients monitored with routine positron emission tomography/computed tomography (PET/CT) surveillance after chemoradiation therapy (CRT). The solid line shows recurrences observed via PET/CT in asymptomatic patients (n = 73). The dashed line shows recurrences observed in patients who presented clinically (n = 37).