Less Frequent Surveillance Scan Policies Effective for Patients with Head and Neck Cancer

A new possible surveillance model suggests that less frequent scan policies can maintain adequate information on relapse status for patients with head and neck cancer (HNC) treated with radiotherapy.¹

A partially observed Markov Decision Process Model could potentially translate into a more cost-effective and time-effective surveillance program for this group of patients. Further multi-institutional and/or international data with a large volume of patient follow-up will be required to determine whether the model has generalizability across larger cohorts.

The data set examined 1,508 patients with mucosal head and neck squamous cell carcinoma treated with definitive radiotherapy and suggested imaging at 9 to 11 months after initial negative posttreatment imaging, rather than frequent imaging every 3 months in the first year. After that, the model suggested imaging at approximately 10-month intervals.

A more conservative model was also constructed, and the interval between follow-up visits was still greater than that in standard practice.

“Ultimately, the aim is to optimize the cost-effectiveness and time-effectiveness of follow-up for an increasing number of survivors of HNC while maximizing the probability of detecting salvageable disease early to optimize salvage outcomes,” the researchers wrote.

A clinical trial released in May of 2017 studied the cost of surveillance imaging in patients with head and neck cancer treated with definitive radiotherapy. After 2 years, the average cost for detecting a salvageable recurrence within the image-detected group was $741,447.41, and the cost for preventing 1 recurrence-related death for image-detected disease was $889,736.89. Additionally, the number of scans required to detect a salvageable recurrence in an asymptomatic patient after 2 years was 3,512.²

Currently there is no clear consensus with regard to the use of surveillance imaging in patients who achieve a complete response after definitive radiotherapy. The National Comprehensive Cancer Network recommends regular clinical assessments at follow up; however, many institutional and trial protocols require patients to undergo follow-up surveillance at regular intervals.

With the current emergence of more effective systemic therapy, such as immunotherapy and targeted therapy, it may be possible that the early detection of recurrent or distant disease, although asymptomatic, may mean that it can be treated effectively with new drugs.

“With increasing follow-up and clinical data from a contemporary cohort, our model can be updated to reflect current practice changes and needs,” the researchers wrote.

A clinical trial released in June of 2019 studied the usefulness of surveillance imaging in patients with head and neck cancer who are treated with definitive radiotherapy and found that, although recurrence was detected earlier with imaging, there was no significant difference in survival observed between patients who had asymptomatic recurrence detected via imaging compared with those who had a recurrence detected clinically.³

According to the National Cancer Institute, head and neck cancers account for approximately 4% of all cancers in the U.S.⁴

References:
1. Ng SP, Ajayi T, Schaefer AJ, et al. Surveillance Imaging for Patients With Head and Neck Cancer Treated With Definitive Radiotherapy: A Partially Observed Markov Decision Process Model. Cncr. doi:10.1002/cncr.23597.
2. Ng SP, Jomaa MK, Pollard C., et al. Cost of surveillance imaging in head and neck cancer patients treated with definitive radiotherapy. Journal of Clinical Oncology. doi:10.1200/JCO.2017.35.15_suppl.6610
3. Ng SP, Pollard III C, Berends J, et al. Usefulness of Surveillance Imaging in Patients with Head and Neck Cancer Who are Treated With Definitive Radiotherapy. Cncr. doi:10.1002/cncr.31983.
4. National Cancer Institute. Head and Neck Cancers. National Cancer Institute website. cancer.gov/types/head-and-neck/head-neck-fact-sheet. Published March 29, 2017. Accessed November 20, 2019.