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Frequency of Follow-up of Oral Cavity and Oropharynx Patients and Appropriate Use of Imaging and Other Surveillance Methodology

  • HEAD & NECK: Oral Cavity and Oropharyngeal Cancer (W Lydiatt, Section Editor)
  • Published:
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Abstract

Purpose of Review

The treatment paradigm for oral cavity and oropharyngeal cancer is shifting. As our treatment strategies change, it calls into question whether surveillance strategies warrant change as well. Therefore, the goal of this paper is to critically review the literature with respect to the current pattern and timing of surveillance and the use of post-treatment imaging in patients with oral cavity and oropharyngeal carcinoma.

Recent Findings

Recent studies suggest that routine surveillance does not improve overall survival, but it does improve locoregional control. Imaging does play an important role in post-operative surveillance.

Summary

Survival following treatment for head and neck cancer is improving. While routine surveillance may not improve overall survival, it still has benefit for patients, particularly in detecting and managing anxiety and post-operative complications.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major Importance

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.

    Article  PubMed  Google Scholar 

  2. Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol. 2015;8:11884–94.

    PubMed  PubMed Central  CAS  Google Scholar 

  3. Weatherspoon D, Chattopadhyay A, Boroumand S, Garcia AI. Oral cavity and oropharyngeal cancer incidence trends and disparities in the United States: 2000-2010. Cancer Epidemiol. 2015;39:497–504.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pfister DG, Spencer S, Adelstein D, et al. NCCN Clinical Practice Guidelines in Oncology- Head and Neck Cancers Version 2.2017- May 8, 2017. NCCN.org

  5. Flynn CJ, Khaouam N, Gardner N, Higgins K, et al. The value of periodic follow-up in the detection of recurrences after radical treatment in locally advanced head and neck cancer. Clin Oncol. 2010;22:868–73.

    Article  CAS  Google Scholar 

  6. Zatterstrom U, Boysen M, Evensen JF. Significance of self-reported symptoms as part of follow-up routines in patients treated for oral squamous cell carcinoma. Anticancer Res. 2014;34:6593–600.

    PubMed  Google Scholar 

  7. Pagh A, Grau C, Overgaard J. A longitudinal study of follow-up activities after curative treatment for head and neck cancer. Acta Oncol. 2015;54:813–9.

    Article  PubMed  Google Scholar 

  8. Digonnet A, Hamoir M, Andry G, Haigentz M, Takes RP, Silver CE, et al. Post-therapeutic surveillance strategies in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2013;270:1569–80.

    Article  PubMed  Google Scholar 

  9. Boysen M, Lovdal O, Tausjo J, Winther F. The value of follow-up in patients treated for squamous cell carcinoma of the head and neck. Eur J Cancer. 1992;28:426–30.

    Article  PubMed  CAS  Google Scholar 

  10. de Visscher AV, Manni JJ. Routine long-term follow-up in patients treated with curative intent for squamous cell carcinoma of the larynx, pharynx, and oral cavity. Does it make sense? Arch Otolaryngol Head Neck Surg. 1994;120:934–9.

    Article  PubMed  Google Scholar 

  11. •• Taslim SJ, Leemans CR, van der Waal I, Karagozoglu KH. Follow-up of oral cancer patients: three uneventful years may be enough. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122:434–9. Demonstrates that surveillance timing and length may be shortened.

    Article  PubMed  Google Scholar 

  12. Manikantan K, Khode S, Dwivedi RC, Palav R, Nutting CM, Rhys-Evans P, et al. Making sense of post-treatment surveillance in head and neck cancer: when and what of follow-up. Cancer Treat Rev. 2009;35:744–53.

    Article  PubMed  Google Scholar 

  13. Lester SE, Wight RG. ‘When will I see you again?’ Using local recurrence data to develop a regimen for routine surveillance in post-treatment head and neck cancer patients. Clin Otolaryngol. 2009;34:546–51.

    Article  PubMed  CAS  Google Scholar 

  14. Merkx MAW, van Gulick JJM, Marres HAM, Kaanders JHAM, Bruaset I, Verbeek A, et al. Effectiveness of routine follow-up of patients treated for T1-T2N0 oral squamous cell carcinomas of the floor of mouth and tongue. Head Neck. 2006;28:1–7.

    Article  PubMed  Google Scholar 

  15. Kanatas A, Bala N, Lowe D, Rogers SN. Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change? British J Oral and Maxillofacial Surg. 2014;52:681–7.

    Article  CAS  Google Scholar 

  16. Noble AR, Greskovich JF, Han J, Reddy CA, Nwizu TI, Khan MF, et al. Risk factors associated with disease recurrence in patients with stage III/IV squamous cell carcinoma of the oral cavity treated with surgery and postoperative radiotherapy. Anticancer Res. 2016;36:785–92.

    PubMed  CAS  Google Scholar 

  17. Patel MA, Blackford AL, Rettig EM, Richmon JD, Eisele DW, Fakhry C. Rising population of survivors of oral squamous cell cancer in the United States. Cancer. 2016;122:1380–7.

    Article  PubMed  Google Scholar 

  18. Agrawal A, deSilva BW, Buckley BM, Schuller DE. Role of the physician versus the patient in the detection of recurrence disease following treatment for head and neck cancer. Laryngoscope. 2004;114:232–5.

    Article  PubMed  Google Scholar 

  19. Ang KK, Harris K, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363:24–35.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Diaz DA, Reis IM, Weed DT, Elsayyad N, Samuels M, Abramowitz MC. Head and neck second primary cancer rates in the human papillomavirus era: a population-based analysis. Head Neck. 2016;38:E873–83.

    Article  PubMed  Google Scholar 

  21. Lin BM, Wang H, D’Souza G, Zhang Z, Fakhry C, et al. Long term prognosis and risk factors among HPV-associated oropharyngeal squamous cell carcinoma patients. Cancer. 2013;119:3462–71.

    Article  PubMed  Google Scholar 

  22. Sumino J, Uzawa N, Ohyama Y, Michi Y, Kawamata A, Mizutani M, et al. First signs of late-presenting cervical lymph node metastasis in oral cancers during follow-up. Int J Oral Maxillofac Surg. 2017;46:676–81.

    Article  PubMed  CAS  Google Scholar 

  23. D’Cruz AK, Vaish R, Neeti K, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. J Engl J Med. 2015;373:521–9.

    Article  CAS  Google Scholar 

  24. Gupta T, Master Z, Kanna S, et al. Diagnostic performance of post-treatment FDG PET or PDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2009;38:2083–95.

    Article  Google Scholar 

  25. Marcus C, Ciarallo A, Tahari AK, Mena E, Koch W, Wahl RL, et al. Head and neck PET/CT: therapy response interpretation criteria (Hopkins criteria)—interreader reliability, accuracy, and survival outcomes. J Nucl Med. 2014;55:1411–6.

    Article  PubMed  CAS  Google Scholar 

  26. Krabbe CA, Pruim J, Dijkstra PU, et al. 18-FDG-PET as routine posttreatment surveillance tool in oral and oropharyngeal squamous cell carcinoma: a prospective study. J Nucl Med. 2009;50:1940–7.

    Article  PubMed  Google Scholar 

  27. Schoder H, Fury M, Lee N, Kraus D. PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nucl Med. 2009;50:74S–88S.

    Article  PubMed  CAS  Google Scholar 

  28. Yao M, Graham MM, Smith RB, Dornfeld KJ, Skwarchuk M, Hoffman HT, et al. Value of FDG PET in assessment of treatment response and surveillance in head and neck cancer patients after intensity modulated radiation treatment: a preliminary report. Int J Radiat Oncol Biol Phys. 2004;60:1410–8.

    Article  PubMed  Google Scholar 

  29. Lee JC, Kim JS, Lee JH, Nam SY, Choi SH, Lee SW, et al. F-18 FDG-PET as routine surveillance tool for the detection of recurrence head and neck squamous cell carcinoma. Oral Oncol. 2007;43:686–92.

    Article  PubMed  CAS  Google Scholar 

  30. Wang S. Surveillance radiologic imaging after treatment of oropharyngeal cancer: a review. World J Surg Oncol. 2015;13:94–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Yu Y, Mabray M, Silveira W, Shen PT, Ryan WR, Uzelac A, et al. Earlier and more specific detection of persistent neck disease with diffusion-weighted MRI versus subsequent PET/CT after definitive chemoradiation for oropharyngeal squamous cell carcinoma. Head Neck. 2017;39:432–8.

    Article  PubMed  Google Scholar 

  32. Mukundun H, Sarin A, Gill BS, Neelakantan A. MRI and PET-CT: comparison in post-treatment evaluation of head and neck squamous cell carcinomas. Med J Armed Forces India. 2014;70:111–5.

    Article  Google Scholar 

  33. Pasha M, Marcus C, Fakhry C, Kang H, Kiess AP, Subramaniam RM. FDG PET/CT for management and assessing outcomes of squamous cell cancer of the oral cavity. AJR. 2015;205:150–61.

    Article  Google Scholar 

  34. Kangelaris GT, Yom SS, Huang K, Wang SJ. Limited utility of routine surveillance MRI following chemoradiation for advanced-stage oropharynx carcinoma. Int J Otolaryngol. 2010;2010:1–5.

    Article  Google Scholar 

  35. •• Hobelmann K, Luginbuhl A, Bar-Ad V, Keane W, Curry J, Cognetti D. Positron emission tomography/computed tomography after primary transoral robotic surgery for oropharyngeal squamous cell carcinoma. Laryngoscope. 2017;127:2050–6. Clearly defines the role for post-operative imaging in HPV-positive OPSCC.

    Article  PubMed  Google Scholar 

  36. Mehanna H, Wong WL, McConkey CC, Rahman JK, Robinson M, Hartley AG, et al. PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med. 2016;374:1444–54.

    Article  PubMed  CAS  Google Scholar 

  37. • Kao SST, Peters MDJ, Kirshnan SG, Ooi EH. Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinoma: a systematic review. Laryngoscope. 2016;126:1572–80. Helps demonstrate the importance of surveillance for managing post-operative outcomes other than survival.

    Article  PubMed  Google Scholar 

  38. Dzioba A, Aalto D, Papadopoulos-Nydam G, et al. Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network. J Otolaryngol Head Neck Surg. 2017;46:56–66.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Giannitto C, Preda L, Zurlo V, Funicelli L, Ansarin M, di Pietro S, et al. Swallowing disorders after oral cavity and pharyngolaryngeal surgery and role of imaging. Gastroenterol Res Pract. 2017;2017:1–9. https://doi.org/10.1155/2017/7592034.

    Article  Google Scholar 

  40. Zhang L, Huang Z, Wu H, Chen W, Huang Z. Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients. Eur J Onc Nurs. 2014;18:626–9.

    Article  Google Scholar 

  41. Moon DH, Moon SH, Wang K, Weissler MC, Hackman TG, Zanation AM, et al. Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers. Oral Oncol. 2017;72:98–103.

    Article  PubMed  Google Scholar 

  42. • Shingler E, Robles LA, Perry R, et al. Tobacco and alcohol cessation or reduction interventions in people with oral dysplasia and head and neck cancer: systematic review protocol. Syst Rev. 2017;6:161. Helps demonstrate the importance of routine visits with physicians for overall health maintenance.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Brianna N. Harris.

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The authors declare that they have no competing interests.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on HEAD & NECK: Oral Cavity and Oropharyngeal Cancer

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Harris, B.N., Gregory Farwell, D. Frequency of Follow-up of Oral Cavity and Oropharynx Patients and Appropriate Use of Imaging and Other Surveillance Methodology. Curr Otorhinolaryngol Rep 6, 292–297 (2018). https://doi.org/10.1007/s40136-018-0204-6

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  • DOI: https://doi.org/10.1007/s40136-018-0204-6

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