title: Safety and cost analysis of an (18)FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation.
abstract: BACKGROUND
  Prognostic information can rationalise clinical follow-up after radical cancer treatment. This retrospective cohort study of radical head and neck (chemo)radiotherapy patients examines the clinical safety and cost implications of stratifying follow-up intensity by post-treatment (18)FDG-PET-CT response.
  
  
  METHODS
  In 2008 clinical review after radical head and neck radiotherapy was reduced from 3- to 6-monthly for patients with complete (18)FDG-PET-CT response at 3months. 184 patients treated after this change ("PET Stratified", 2009-11) were compared to 178 patients treated before ("Standard", 2005-7). Clinical safety was assessed by the time to detection of recurrence, overall survival and potential for radical treatment of recurrence. A hospital cost analysis was performed using individual patient data.
  
  
  RESULTS
  127 of 178 Standard and 148 of 184 PET Stratified patients achieved complete response on post-treatment imaging. Baseline clinical characteristics were comparable. Median follow-up from response assessment was 4.8years in the Standard cohort and 2.1years for PET Stratified. PET Stratified patients had a mean 4.4 outpatient visits in 2years, compared to 7.0 among Standard patients. Over 90% of patients remained free of recurrence at 2years in both cohorts. Time to detection of recurrence was similar between two cohorts (HR1.05, 95%CI 0.45-2.52), as was overall survival (HR0.91, 95%CI 0.36-2.29). The proportion of radically treatable recurrences was also similar (42% Standard vs. 47% PET Stratified). The hospital cost savings per patient from reduced review were AUD$2606 over 2years, AUD$5012 over five.
  
  
  CONCLUSIONS
  (18)FDG-PET-CT to stratify follow-up intensity after radical radiotherapy for head and neck cancer reduces costs with no apparent clinical detriment.
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. Electronic address: ketan.shah@doctors.org.uk.
authors.forename: Ketan
authors.initials: K
authors.lastname: Shah
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Luc
authors.initials: L
authors.lastname: Te Marvelde
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Marnie
authors.initials: M
authors.lastname: Collins
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: De Abreu Lourenco
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Ieta
authors.initials: I
authors.lastname: D'Costa
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Coleman
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Tsien
authors.initials: T
authors.lastname: Fua
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Rischin
authors.affiliation: Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: Eddie
authors.initials: E
authors.lastname: Lau
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Corry
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy; D017721:Hospital Costs; D006801:Humans; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Economics; Follow-up studies; Head and neck neoplasms; Health services research; Positron-emission tomography