Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Otolaryngology Head and Neck Surgery, Henry Ford Cancer Institute and Hospital, Detroit, Michigan.
Int J Radiat Oncol Biol Phys. 2024 Jul 1;119(3):786-802. doi: 10.1016/j.ijrobp.2023.12.024. Epub 2023 Dec 31.
Surveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, the use of surveillance imaging for asymptomatic patients with HNC is controversial. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for head and neck squamous cell carcinoma and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios. The evidence base for the appropriate use criteria was gathered through a librarian-mediated search of literature published from 1990 to 2022 focused on surveillance imaging and circulating tumor-specific DNA for nonmetastatic head and neck squamous cell carcinoma using MEDLINE (Ovid), Embase, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials. The systematic review was reported according to PRISMA guidelines. Using the modified Delphi process, the expert panel voted on appropriate use criteria, providing recommendations for appropriate use of surveillance imaging and human papillomavirus (HPV) circulating tumor DNA. Of 5178 studies identified, 80 met inclusion criteria (5 meta-analyses/systematic reviews, 1 randomized control trial, 1 post hoc analysis, 25 prospective, and 48 retrospective cohort studies [with ≥50 patients]), reporting on 27,525 patients. No large, randomized, prospective trials examined whether asymptomatic patients who receive surveillance imaging or HPV circulating tumor DNA monitoring benefit from earlier detection of recurrence or second primary tumors in terms of disease-specific or quality-of-life outcomes. In the absence of prospective data, surveillance imaging for HNC survivors should rely on individualized recurrence-risk assessment accounting for initial disease staging, HPV disease status, and tobacco use history. There is an emerging surveillance role for circulating tumor biomarkers.
头颈部癌症（HNC）幸存者的监测重点是早期发现复发性或第二原发恶性肿瘤。在初始分期确认无疾病状态后，对于无症状的 HNC 患者，使用监测成像存在争议。我们的目标是全面审查与头颈部鳞状细胞癌治疗后无症状患者的成像和生物标志物监测相关的文献，并召集一个多学科专家小组，为代表性临床情况下的监测提供适当的使用标准。适当使用标准的证据基础是通过图书馆员介导的文献检索获得的，这些文献是从 1990 年至 2022 年发表的，重点是使用 MEDLINE（Ovid）、Embase、Web of Science 核心合集和 Cochrane 对照试验中心注册处针对非转移性头颈部鳞状细胞癌的监测成像和循环肿瘤特异性 DNA 进行的研究。系统评价按照 PRISMA 指南进行报告。使用改良 Delphi 过程，专家小组对适当使用标准进行了投票，为监测成像和人乳头瘤病毒（HPV）循环肿瘤 DNA 的适当使用提供了建议。在确定的 5178 项研究中，有 80 项符合纳入标准（5 项荟萃分析/系统评价、1 项随机对照试验、1 项事后分析、25 项前瞻性和 48 项回顾性队列研究[至少有 50 名患者]），共报告了 27525 名患者。没有大型、随机、前瞻性试验研究过接受监测成像或 HPV 循环肿瘤 DNA 监测的无症状患者是否能从早期发现复发或第二原发肿瘤中获益，无论是在疾病特异性还是生活质量方面。在缺乏前瞻性数据的情况下，HNC 幸存者的监测成像应依赖于个体化的复发风险评估，评估因素包括初始疾病分期、HPV 疾病状态和吸烟史。循环肿瘤生物标志物的监测作用正在出现。
