Abstract
BackgroundPost treatment lung screening for head and neck cancer patients primarily focuses on the distant metastasis and a high rate of second primary can also be expected. The best screening tool and timing for this purpose is controversial. We sought out to assess the current practice and beliefs among Canadian Head and Neck Surgeons.MethodsAfter Ethical Board approval, a nationwide survey was conducted through the Canadian Society of Otolaryngology (CSO) among head and neck surgeons regarding their practices for pulmonary screening in HNSCC patients.ResultsOur CSO survey among Otolaryngology-head and neck surgeons showed that 26 out of 32 respondents perform routine lung screen, out of which 23 (88%) feel that chest radiography should be preferred. The majority of respondents felt that lung screening could impact beneficially on mortality. For symptomatic patients, low-dose spiral CT was the preferred modality (48%), followed by PET/CT scan (14%) and sputum cytology (14%). In high-risk asymptomatic patients (current smoker, radiation exposure, family history and advanced HNSCC), 31% of respondents performed a CXR. The same percentage performed a low dose CT, while 19% relied on PET scan. A further 19% of respondents did not perform any screening in high-risk patients. Most respondents (77%) had more than 10 years practice since graduation from medical school and came from the provinces of Quebec, Ontario and Alberta.ConclusionChest radiography remains the preferred modality for lung screening and was believed to be impacting beneficially on lung mortality. The recent literature does not seem to be in agreement with those beliefs. Further studies to establish which modality is best and concurrent nation-wide education are warranted.
Highlights
In head and neck squamous cell carcinoma patients (HNSCC), post treatment surveillance for distant disease is mostly focusing on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of the cases and a high rate of primary of the lungs can be expected due to field cancerization of the entire upper aerodigestive tract
Distant metastasis isolated to other sites such as liver or bones are rare in the absence of simultaneous pulmonary malignancy [4]
After Ethics Review Board approval, a nationwide survey was conducted through the Canadian Society of Otolaryngology (CSO) among Otolaryngology-head and neck
Summary
In head and neck squamous cell carcinoma patients (HNSCC), post treatment surveillance for distant disease is mostly focusing on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of the cases and a high rate of primary of the lungs can be expected due to field cancerization of the entire upper aerodigestive tract [1,2,3,4]. Overall, screening for distant metastasis has gained importance in the last few years, as aggressive locoregional treatment in HNSCC has led to better locoregional control but higher risk of distant failure [10]. This reverse failure pattern was first reported by Vikram et al [10], who showed that only 15% of patients relapsed above the clavicle, as opposed to 70% in historical series. Post treatment lung screening for head and neck cancer patients primarily focuses on the distant metastasis and a high rate of second primary can be expected. We sought out to assess the current practice and beliefs among Canadian Head and Neck Surgeons
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