title: Post-therapeutic surveillance strategies in head and neck squamous cell carcinoma.
abstract: The management of head and neck squamous cell carcinomas does not end with the completion of ablative therapy. The oncologic objectives of post-treatment follow-up are to detect recurrences and second primary tumors; beyond that, follow-up should evaluate acute and chronic treatment-related side effects, guide the rehabilitation process, alleviate functional loss, manage pain, restore nutritional status and assess psychosocial factors. In this structured review, we address the questions of timing and the tools required to achieve a complete and coherent routine surveillance. Several guidelines and consensus statements recommend clinical examination as the cornerstone of follow-up which should be performed for at least 5 years, although there are no data in favor of any one particular follow-up program, and only low-level evidence suggests an improvement in oncologic outcomes by close follow-up. Baseline imaging (computed tomography and magnetic resonance imaging) should be obtained within 2-6 months after definitive therapy if used for treatment response evaluation. Metabolic response, if indicated, should be assessed preferably after 3 months in patients who undergo curative-intent therapy with (chemo)-radiotherapy. Chest computed tomography is more sensitive than plain radiography, if used in follow-up, but the benefit and cost-effectiveness of routine chest computed tomography has not been demonstrated. There are no current data supporting modifications specific to the surveillance plan of patients with human papillomavirus-associated disease.
authors.affiliation: Department of Head and Neck and Thoracic Surgery, Institut Jules Bordet, Brussels, Belgium.
authors.forename: Antoine
authors.initials: A
authors.lastname: Digonnet
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.forename: Guy
authors.initials: G
authors.lastname: Andry
authors.forename: Missak
authors.initials: M
authors.lastname: Haigentz
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: Andreas
authors.initials: A
authors.lastname: Dietz
authors.forename: Vincent
authors.initials: V
authors.lastname: Grégoire
authors.forename: Vinidh
authors.initials: V
authors.lastname: Paleri
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Vincent
authors.initials: V
authors.lastname: Vander Poorten
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hinni
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: Jochen A
authors.initials: JA
authors.lastname: Werner
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013997:Time Factors; D014057:Tomography, X-Ray Computed