Head and Neck Surgery Service, Brazilian National Cancer Institute, Department of Head and Neck Surgery, Post Graduate School of Medicine, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
Curr Oncol Rep. 2013 Apr;15(2):119-27. doi: 10.1007/s11912-012-0287-z.
Accurate early diagnosis and staging is an essential step in the management of recurrent head and neck cancer. Nevertheless, the diagnosis and staging of recurrent head and neck cancer previously treated by radiation therapy often combined with chemotherapy, remains a challenge. The differentiation between radiation induced reaction and recurrent cancer is a difficult clinical and radiological problem. It is clear that timely diagnosis in case of residual or recurrent tumor is of great importance to increase the possibility of cure. A variety of interventions such as office clinical examinations, blood tests, serum tumor marker measurements, imaging studies and endoscopies are being used to follow-up these patients. No single intervention proved to be absolute or complete in being simultaneously sensitive, specific, inexpensive, safe and efficient at detecting suspected recurrence of head and neck cancer, particularly after chemoradiation. In addition to that, there is no clear evidence of what surveillance regimen or frequency is considered the most adequate or effective in this setting. In this article, we analyze the diagnostic difficulties of tumor recurrence after combined treatment with chemotherapy plus radiation therapy and review the role of clinical, endoscopic and imaging techniques in the follow-up of these patients.
准确的早期诊断和分期是复发性头颈部癌症管理的重要步骤。然而，对于先前接受过放疗联合化疗治疗的复发性头颈部癌症的诊断和分期仍然是一个挑战。区分放射性反应和复发性癌症是一个具有挑战性的临床和影像学问题。显然，及时诊断残留或复发性肿瘤对于提高治愈的可能性非常重要。各种干预措施，如门诊临床检查、血液检查、血清肿瘤标志物测量、影像学研究和内窥镜检查，用于对这些患者进行随访。没有一种干预措施被证明在同时具有敏感性、特异性、经济性、安全性和效率方面是绝对或完全的，能够用于检测头颈部癌症的可疑复发，特别是在放化疗后。此外，在这种情况下，哪种监测方案或频率被认为是最合适或最有效的，目前还没有明确的证据。本文分析了化疗联合放疗综合治疗后肿瘤复发的诊断困难，并综述了临床、内镜和影像学技术在这些患者随访中的作用。
