Szturz Petr, Van Laer Carl, Simon Christian, Van Gestel Dirk, Bourhis Jean, Vermorken Jan B
Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
Front Oncol. 2020 May 6;10:688. doi: 10.3389/fonc.2020.00688. eCollection 2020.
The traditional concept of post-treatment surveillance in head and neck cancer patients relies on examinations directed at early detection of disease recurrence and/or second primary tumors. They are usually provided by ear, nose and throat specialists with complementary input from radiation oncologists and medical oncologists. Emerging evidence underscores the importance of monitoring and effective management of late adverse events. One of the major drawbacks is a lack of prospective controlled data. As a result, local institutional policies differ, and practice recommendations are subject to continuing debate. Due to the economic burden and impact on emotional comfort of patients, intensity and content of follow-up visits are a particularly conflicting topic. According to the current evidence-based medicine, follow-up of head and neck cancer patients does not prolong survival but can improve quality of life. Therefore, an approach giving priority to a multidisciplinary care involving a speech and swallowing expert, dietician, dentist, and psychologist may indeed be more relevant. Moreover, on a case-by-case basis, some patients need more frequent consultations supplemented by imaging modalities. Human papillomavirus positive oropharyngeal cancer tends to develop late failures at distant sites, and asymptomatic oligometastatic disease, especially in the lungs, can be successfully salvaged by local ablation, either surgically or by radiation. The deep structures of the skull base related to the nasopharynx are inaccessible to routine clinical examination, advocating periodic imaging supplemented by nasofibroscopy as indicated. Anamnesis of heavy smoking justifies annual low-dose computed tomography screening of the thorax and intensive smoking cessation counseling. Finally, some cancer survivors feel more comfortable with regular imaging, and their voice should be taken into consideration. Future development of surveillance strategies will depend on several variables including identification of reliable predictive factors to select those who could derive the most benefit from follow-up visits, the availability of long-term follow-up data, the results of the first randomized trials, resource allocation patterns, infrastructure density, and the therapeutic landscape of locally advanced and recurrent and/or metastatic disease, which is rapidly changing with the advent of immune checkpoint inhibitors and better utilization of local approaches.
头颈部癌患者治疗后监测的传统概念依赖于旨在早期发现疾病复发和/或第二原发性肿瘤的检查。这些检查通常由耳鼻喉科专家提供，并由放射肿瘤学家和医学肿瘤学家提供补充意见。新出现的证据强调了监测和有效管理晚期不良事件的重要性。主要缺点之一是缺乏前瞻性对照数据。因此，各地的机构政策各不相同，实践建议也一直存在争议。由于经济负担以及对患者情绪舒适度的影响，随访的强度和内容是一个特别有争议的话题。根据当前的循证医学，对头颈部癌患者进行随访并不能延长生存期，但可以提高生活质量。因此，优先采用多学科护理方法，包括言语和吞咽专家、营养师、牙医和心理学家，可能确实更合适。此外，根据具体情况，一些患者需要更频繁的会诊，并辅以影像学检查。人乳头瘤病毒阳性的口咽癌往往在远处发生晚期复发，无症状的寡转移疾病，尤其是肺部的，可通过手术或放疗等局部消融成功挽救。常规临床检查无法触及与鼻咽相关的颅底深部结构，因此建议定期进行影像学检查，并根据需要辅以鼻纤维镜检查。大量吸烟史的患者有必要每年进行一次胸部低剂量计算机断层扫描筛查，并接受强化戒烟咨询。最后，一些癌症幸存者对定期影像学检查感觉更安心，他们的意见应予以考虑。监测策略的未来发展将取决于几个变量，包括识别可靠的预测因素以选择那些能从随访中获益最大的患者、长期随访数据的可用性、首批随机试验的结果、资源分配模式、基础设施密度，以及局部晚期和复发和/或转移性疾病的治疗格局，随着免疫检查点抑制剂的出现和局部治疗方法的更好利用，这种格局正在迅速变化。
