Effectiveness of routine follow-up of patients treated for T1-2N0 oral squamous cell carcinomas of the floor of mouth and tongue.
BACKGROUND
The duration of follow-up after treatment for head and neck cancer, the depth of the routine visits, and the diagnostic tools used are determined on the basis of common acceptance rather than evidence-based practice. Patients with early-stage tumors are more likely to benefit from follow-up programs, because they have the best chance for a second curative treatment after recurrence. The purpose of this study was to determine the benefit of our 10-year follow-up program in patients with stage I and II squamous cell carcinoma (SCC) of the floor of mouth and tongue.


METHODS
In a longitudinal cohort study involving 102 patients who were treated with curative intent for a pT1-2N0M0 SCC of the floor of mouth and tongue from 1989-1998 with a minimum follow-up of 5 years, we evaluated the effect of routine follow-up.


RESULTS
During the follow-up (mean, 61 months; SD, 4 months), 10 patients had a recurrence, and 20 patients had a second primary tumor. No regional lymph node recurrences in the neck were detected. Location, T classification of the primary tumor, choice of therapy, or measure of tumor-free margins in the resection did not significantly affect the occurrence of a secondary event (p >or= .1). The secondary event was discovered during a patient-initiated visit for complaints in 14 patients and was found during routine follow-up visits in 16 patients. Only seven second primary tumors were detected after 60 months, four on routine follow-up and three on a self-initiated visit. The mean disease-free survival time after treatment of the secondary event was 72 months (SD, 17 months) in the "own initiative" group and 65 months (SD, 13 months) in the routine follow-up group; this difference was not statistically significant (p=.3).


CONCLUSIONS
The effectiveness of a 10-year routine follow-up, even in patients with early-stage oral SCC, is very limited. These visits on routine basis can be stopped after 5 years.
Merkx
Matthias Adrianus Wilhelmus
MA
Department of Oral and Maxillofacial Surgery, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands. m.merkx@mkc.nl
van Gulick
Joris Jan Martijn
JJ
Marres
Henri August Marie
HA
Kaanders
Johannus Hendrikus Antonius Maria
JH
Bruaset
Ingolv
I
Verbeek
André
A
de Wilde
Peter Christianus Martinus
PC
D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000628:therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014062:Tongue Neoplasms / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome