Routine Surveillance Scanning in Patients With Squamous Cell Carcinoma of the Head and Neck: Lung Screening CT Scans Have Value but Head and Neck Scans Do Not Identify Patients Who Achieve Long-Term Disease Control

Abstract

To examine the utility of computed tomography (CT) imaging as a routine surveillance tool for the detection of recurrent head and neck squamous cell carcinoma (HNSCC). Clinical characteristics of HNSCC patients treated between 2008-2017 with radiation therapy (RT) or concurrent chemoradiation (CCRT) were abstracted from medical records. In patients who achieved a complete clinical response (CCR) to treatment by positron emission tomography (PET) 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. Overall survival (OS) curves and multivariate cox proportional hazard ratios (HR) were examined. At this single institution, 588 patients were treated for HNSCC. Median follow up duration for the entire cohort was 30.9 months (range = 6-88 months). Of the 449 (76%) evaluable patients who achieved a CCR, 85 (19%) patients had a recurrence. Among the 85 patients with disease recurrence, 25 (29%) 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. One patient was successfully salvaged for both local and distant failure. Maxillofacial and neck screening CT imaging failed to detect any successfully salvaged patients. Routine surveillance for HNSCC patients with lung CT imaging had value but 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 screenings. Surveillance head and neck CT imaging is not recommended until better salvage treatment is available to treat locoregional recurrence.