More Intensive Imaging Follow-Up in Head, Neck Cancer?


Patients with advanced-stage head and neck squamous cell carcinoma (HNSCC) who were monitored with an intensive post-treatment follow-up strategy using 18F-fludeoxyglucose-positron emission tomography with CT (18F-FDG-PET/CT) demonstrated significant survival benefits over 3 years compared with those who received conventional follow-up.


  • The use of intensive posttreatment follow-up imaging with 18F-FDG-PET/CT is optional and is typically used for patients who have locally advanced disease at diagnosis. Wider use of 18F-FDG-PET/CT in this population remains controversial. Debates center on cost-effectiveness.

  • The case-control study included 782 patients with HNSCC who had achieved a complete response on imaging at 3 to 6 months.

  • Overall, 82.1% of the patients were men (median age, 61 years).

  • On the basis of physician discretion, 497 of patients who underwent an intensive posttreatment follow-up strategy received 18F-FDG-PET/CT at months 12, 24, and 36. The remaining 285 patients underwent conventional follow-up.

  • On the basis of current guidelines, conventional follow-up involves clinical examination in the first 3 years after treatment and CT, MRI, or both within 3 to 6 months after treatment.


  • The mean 3-year overall survival was significantly better in the 18F-FDG-PET/CT follow-up group than in the conventional follow-up group (72.5% vs 64.3%; P = .002).

  • A Cox regression analysis showed a significantly lower risk of death among the 18F-FDG-PET/CT group at 3 years compared with the group that received conventional follow-up (odds ratio, 0.71) after the analysis was adjusted for factors that included age, sex, comorbidities, primary location, stage, surgeon, year of treatment, and treatment.

  • A significant 3-year overall survival benefit was observed among patients with more advanced-stage HNSCC (stage III and IV) — 68.5% in the 18F-FDG-PET/CT group vs 55.4% in the conventional group — but not among those with stage I or II HNSCC.

  • In the PET/CT group, patients with oropharyngeal tumors also demonstrated significantly longer mean 3-year overall survival (69.9% vs 60.5%; P = .04).


“This case-control study found that use of 18FDG-PET/CT as an alternative to annual chest CT in the follow-up of HNSCC was associated with incremental 3-year overall survival benefit, specifically in patients with advanced disease at diagnosis (stage III-IV) or oropharyngeal primary tumors,” the authors said.


The study was led by Ronan Abgral, MD, PhD, of Nuclear Medicine Department, University Hospital of Brest, France, and was published online August 1 in JAMA Network Open.


  • There was a greater number of patients in the PET/CT group than in the conventional follow-up group, and the choice of follow-up modalities was at the discretion of the ear, nose, and throat surgeon.

  • Patient characteristics were less favorable in the PET/CT group, which could have affected the difference in survival between groups.

  • The follow-up period was limited to 3 years, and most recurrent events were diagnosed over the first 2 years. Thus, “the optimal follow-up schedule and duration remain to be determined,” the authors noted.


Co-author Gregoire Le Gal has received grants from Pfizer and Bristol-Myers Squibb and personal fees from Pfizer, Sanofi, and Aspen Pharmacare outside the submitted work. No other relevant financial relationships were reported.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

Source: Read Full Article