Routine surveillance scanning in HNSCC: Lung screening CT scans have value but head and neck scans do not

• Main Authors: Arshad, H. (Author), Degraaff, L. (Author), Duncan, W.D (Author), Gupta, V. (Author), Hicks, W.L., Jr (Author), Iovoli, A.J (Author), Kuriakose, M.A (Author), Platek, A.J (Author), Platek, M.E (Author), Singh, A.K (Author), Wang, C. (Author), Wooten, K.E (Author)
• Format: Article
• Language: English
• Published: Elsevier Ltd 2018
• Subjects: adult; aged; Aged; Article; cancer patient; cancer radiotherapy; Carcinoma; chemoradiotherapy; Chemoradiotherapy; concurrent chemoradiation; diagnostic imaging; female; Female; follow up; Follow-Up Studies; head; Head; Head and neck neoplasms; Head and Neck Neoplasms; head and neck squamous cell carcinoma; head and neck tumor; human; Humans; Lung Neoplasms; lung tumor; major clinical study; male; Male; mass screening; Mass Screening; medical record; middle aged; Middle Aged; multimodality cancer therapy; neck; Neck; Neoplasm recurrence; Neoplasm Recurrence, Local; pathology; positron emission tomography; priority journal; procedures; recurrent disease; Retrospective Studies; retrospective study; salvage therapy; Salvage therapy; Salvage Therapy; Squamous cell; Squamous Cell Carcinoma of Head and Neck; thorax radiography; Tomography; Tomography, X-Ray Computed; treatment outcome; Treatment Outcome; treatment response; tumor recurrence; X-ray computed; x-ray computed tomography
• Online Access: View Fulltext in Publisher

 Objectives: To examine the utility of computed tomography (CT) imaging during routine surveillance for the detection of recurrent head and neck squamous cell carcinoma (HNSCC). Materials/methods: Clinical characteristics of HNSCC patients treated between 2008 and 2017 with radiation therapy or concurrent chemoradiation were abstracted from medical records. In patients who achieved a complete response to treatment by positron emission tomography scan, surveillance CT scans were conducted to the maxillofacial area, neck, and chest every 3 months in year 1, every 6 months in year 2, and every 12 months in years 3 and beyond. Results: Within the entire cohort (n = 534), complete response was achieved in 446 patients (83.5%); of these, 84 (15.7%) patients had a recurrence. Among the 84 patients with disease recurrence, 25 (30%) patients remained alive, of which 15 (18%) underwent successful salvage treatment and became free of disease. Lung screening CT scans detected failure in 8 of these successfully salvaged patients. Among the 8 patients successfully salvaged for locoregional recurrence, 3 failures were asymptomatic at onset and detected by laryngoscope or dental exam. The remaining 5 failures were symptomatic and detected upon work up prompted by symptoms. Maxillofacial and neck surveillance CT imaging failed to detect any successfully salvaged patients. Conclusions: Routine surveillance for HNSCC patients with lung CT imaging had value but routine head and neck CT scans failed to identify any successfully salvaged patients. Given this finding, routine CT imaging surveillance in HNSCC patients should be restricted to annual lung screening with low-dose chest CT. © 2018