Follow-up in Head and Neck Cancer: Do More Does It Mean Do Better? A Systematic Review and Our Proposal Based on Our Experience

Abstract

As the patients population ages, cancer screening increases, and cancer treatments improve, millions more head and neck carcinoma (HNC) patients will be classified as cancer survivors in the future. Change in epidemiology with human papillomavirus related HNC leads to a number of young treated patients. After treatment for HNC intensive surveillance, including ear, nose and throat (ENT) endoscopy, imaging, and serology, confers a survival benefit that became less evident in unresectable recurrence. We performed a comprehensive revision of literature and analyzed the experience of our centre. We revised publications on this topic and added data derived from the interdisciplinary work of experts within medical oncology, ENT, and radiation oncology scientific societies. We retrospectively collected local and distant recurrence of chemoradiation treated patients at Santa Croce and Carle University Hospital. A HNC follow-up program is not already codified and worldwide accepted. There is a need of scheduled follow-up. We suggest adopting a standardized follow-up guideline, although a multidisciplinary approach is frequently requested to tailor surveillance program and treatment on each patient.

Keywords: Head and Neck Neoplasms; Human Papillomavirus; Imaging; Second Primary Tumor; Surveillance.

Fig. 1.

Follow-up algorithms. For each subsite TSH annually, smoking and alcohol cessation suggested to all patients. Clinical examination according to National Comprehensive Cancer Network should include ear, nose and throat evaluation, pain/xerostomia/depression management, nutritional support, dental care, and speech and swallowing therapy. All CT scan and MRI are considered with contrast. Patients with PS >2, or with comorbidity that contraindicate treatment are not followed up for the disease. TNM, tumor-node-metastasis; CT, computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography; PS, performance status; TSH, thyroid stimulating hormone; CRT, chemoradiation; M, months; NFE, nasal/pharyngo/laryngeal fiber optic examination; ACF, anterior cranial fossa; MCF, medial cranial fossa; vc, vocal cord. ^a)If doubt of recurrence or metastatic disease. ^b)If smoking history >20 pack year. ^c)T3-4 close margin.