Follow the data.

Top Line: Few patients receive closer surveillance than those following definitive radiation for locally-advanced head and neck cancers.

The Study: As it stands, all of the varied head and neck cancers are lumped together in one NCCN surveillance algorithm with laryngoscopic exams ranging anywhere from q1-8 months for the first five years. This practical retrospective study with complex modeling on 673 patients receiving treatment at two large referral centers in Seoul aimed to crystallize these recs a bit further. Rates of tumor recurrence and/or death were as follows: nasopharynx 19% (43/227), HPV+ oropharynx 15% (35/237), HPV- oropharynx 36% (17/47), hypopharynx 45% (29/65), and larynx 31% (30 of 97). None of this is surprising to anyone who treats head and neck cancers, but the modeling is where things get actionable. Parametric modeling output quite varied surveillance intervals for each disease site in order to miss no more than 5% of recurrences. On one end of the spectrum, hypopharyngeal cancers had an optimal surveillance regimen of q2 months until month 16, q3 months until year 2, and q6 months until year 8. On the other end, HPV+ oropharyngeal cancers had an optimal surveillance regimen of q8 months until month 16, q14 months until year 2, and q34 months until year 8. Everything else, of course, fell somewhere in the middle.

TBL: The threshold for spacing out high-burden follow-up appointments for low-risk head and neck cancers should probably be pretty low. | Lee, JAMA Otolaryngol Head Neck Surg 2022