Imaging and Biomarker Surveillance for Head and Neck Squamous Cell Carcinoma: A Systematic Review and American Radium Society Appropriate Use Criteria Statement

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PurposeSurveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, there is controversy regarding the use of surveillance imaging for asymptomatic patients with HNC. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for HNSCC, and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios. Materials and methodsThe evidence base for the appropriate use criteria was gathered through a librarian-mediated search of literature published from 1990-2022 focused on surveillance imaging and circulating tumor-specific DNA for non-metastatic HNSCC using MEDLINE (Ovid®), Embase, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials. The systematic review was reported according to PRISMA guidelines. Through the modified Delphi process, the expert panel voted on appropriate use criteria, providing recommendations for appropriate use of surveillance imaging and circulating tumor human papillomavirus DNA (HPV ctDNA). ResultsOf 5,178 studies, 80 met inclusion criteria (5 meta-analyses/systematic reviews, 1 randomized control trial, 1 post-hoc analysis, 25 prospective and 48 retrospective cohort studies [with ≥50 patients]) reporting on 27,525 total patients. Large, randomized, prospective trials are lacking to address whether asymptomatic patients that receive surveillance imaging or HPV ctDNA monitoring benefit from earlier detection of recurrence or second primary tumors in terms of disease-specific or quality of life outcomes. ConclusionsIn the absence of prospective data, surveillance imaging for HNC survivors should rely on individualized recurrence-risk assessment accounting for initial disease staging, HPV disease status, and tobacco use history. There is an emerging surveillance role for circulating tumor biomarkers.