TOPLINE:
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.
METHODOLOGY:
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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.
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The case-control study included 782 patients with HNSCC who had achieved a complete response on imaging at 3 to 6 months.
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Overall, 82.1% of the patients were men (median age, 61 years).
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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.
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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.
TAKEAWAY:
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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).
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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.
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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.
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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).
IN PRACTICE:
“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.
SOURCE:
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.
LIMITATIONS:
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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.
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Patient characteristics were less favorable in the PET/CT group, which could have affected the difference in survival between groups.
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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.
DISCLOSURES:
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.
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