Making sense of post-treatment surveillance in head and neck cancer: when and what of follow-up.
Follow-up in patients treated for head and neck cancer (HNC) is aimed at early detection of recurrence, metastases and second primary tumours. Various modalities for the routine follow-up of patients with HNC have been proposed and studied in the literature. Consequently, practising head and neck surgeons and oncologists all over the world use different guidelines and protocols to follow-up their patients. These guidelines involve follow-up intervals of varying intensity and schedule an assortment of investigations that may be neither logical nor practical. This follow-up process may be difficult to administrate, cause unnecessary discomfort and morbidity to the patient and can have serious cost-implications to the healthcare system. This review summarises strategies for follow-up, imaging modalities and key investigations in the literature published between 1980 and 2009. In this structured review, we have assessed studies in the literature that have addressed follow-up intervals, imaging tests, tumour markers, endoscopy and thyroid function tests as a part of the routine post-treatment surveillance in HNC patients. Studies analysing the cost benefit of such surveillance have also been addressed. Based on the evidence presented, we have compiled definitive recommendations for effective surveillance/post-treatment follow-up in patients with HNC.
Manikantan
Kapila
K
Department of ENT and Head and Neck surgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai 400008, India. kapila.manikantan@gmail.com
Khode
Shailesh
S
Dwivedi
Raghav C
RC
Palav
Rajan
R
Nutting
Chris M
CM
Rhys-Evans
Peter
P
Harrington
Kevin J
KJ
Kazi
Rehan
R
D014408:Biomarkers, Tumor / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004724:Endoscopy; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009819:Office Visits; D011159:Population Surveillance / Q000379:methods*; D049268:Positron-Emission Tomography; D013960:Thyroid Function Tests; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D014408:Biomarkers, Tumor