Routine long-term follow-up in patients treated with curative intent for squamous cell carcinoma of the larynx, pharynx, and oral cavity. Does it make sense?

OBJECTIVE

To evaluate whether additional curative treatment was possible in patients for whom routine long-term follow-up had led to the early detection of locoregional recurrence, distant metastases, and second primary tumors (events).

DESIGN

Cohort study with a maximum follow-up of 126 months and a consensus questionnaire.

SETTING

Department of Head and Neck Oncology at the University Hospital Nijmegen (the Netherlands).

PATIENTS

There were 428 patients treated with curative intent for carcinoma of the larynx, pharynx, and oral cavity from 1979 to 1983.

MAIN OUTCOME MEASURES

Site, stage, differentiation grade, and type of treatment of index tumor (routine follow-up vs self-referral).

RESULTS

There were 205 patients (47.9%) who developed events, 76.1% within 3 years of initial treatment. Eighty-nine patients (43.4%) received curative treatment. The detection rate for events during routine follow-up (6350 appointments) was one in 34, and for self-referrals (54) it was one in 2.7; the cure rates were one in 78 and one in 6.8, respectively. The mean survival after detection of events with routine follow-up was significantly (P < .05) better than with self-referral (58 vs 32 months, respectively).

CONCLUSIONS

Routine follow-up is indispensible. Site and stage of the index tumor played a part in the length of routine follow-up, in contrast to the differentiation grade or type of initial treatment. Yearly chest roentgenograms were valuable only for laryngeal index tumors. Patients considered routine follow-up important; however, negative findings at physical examination of complaints did not reassure all patients.