Marchant F E, Lowry L D, Moffitt J J, Sabbagh R
Department of Otolaryngology--Head and Neck Surgery, Jefferson Medical College, Philadelphia, PA.
Am J Otolaryngol. 1993 Mar-Apr;14(2):88-93. doi: 10.1016/0196-0709(93)90045-9.
Follow-up of individuals treated for a primary squamous carcinoma of the upper aerodigestive tract is critical because of the high risk of development of either recurrent disease or a new primary tumor. A mail survey of physicians actively practicing head and neck surgery was undertaken.
A multiple-choice survey was distributed to 400 members of the American Society for Head and Neck Surgery. Respondents indicated approach to post-treatment follow up.
Surveys were returned from 290 members (73%). Routine monthly follow up is advocated by 73% of respondents during the first postoperative year. Patients are followed every 2 to 3 months in the second postoperative year by 90% of respondents. During postoperative years, 3 to 5 patients are seen every 4 to 6 months by 97% of respondents. All respondents see patients either semiannually or annually for the remainder of their lives. Sixty percent of respondents advocate annual screening chest radiographs, whereas 14% do not order routine chest radiographs. The overwhelming majority of respondents reserve barium swallow and computed tomographic (CT) scans for evaluation of symptomatic patients. Similarly, nuclear imaging is reserved for patients with specific symptoms or abnormal laboratory tests. Blood tests most frequently monitored include complete blood cell count (CBC) (43%), thyroid function test (22%), and liver function test (20%). Follow-up endoscopic evaluation under anesthesia is reserved for symptomatic patients by over 95% of respondents.
These data demonstrate that head and neck surgeons rarely use supplemental studies other than chest radiograph during routine follow up. The authors speculate that routine chest radiograph may be valuable in screening for a second primary carcinoma. Techniques to screen for esophageal tumors remain contentious.
对上呼吸道和消化道原发性鳞状细胞癌患者进行随访至关重要，因为复发疾病或新发原发性肿瘤的发生风险很高。我们对积极从事头颈外科手术的医生进行了一项邮件调查。
向400名美国头颈外科学会会员发放了一份多项选择调查问卷。受访者表明了治疗后随访的方法。
290名会员（73%）回复了调查问卷。73%的受访者主张在术后第一年进行每月一次的常规随访。在术后第二年，90%的受访者每2至3个月对患者进行一次随访。在术后第3至5年，97%的受访者每4至6个月看诊3至5名患者。所有受访者在患者余生中每半年或每年看诊一次。60%的受访者主张每年进行胸部X光筛查，而14%的受访者不安排常规胸部X光检查。绝大多数受访者仅在患者出现症状时才安排吞咽钡剂造影和计算机断层扫描（CT）。同样，核医学成像仅用于有特定症状或实验室检查异常的患者。最常监测的血液检查项目包括全血细胞计数（CBC）（43%）、甲状腺功能检查（22%）和肝功能检查（20%）。超过95%的受访者仅在患者出现症状时才安排麻醉下的内镜随访评估。
这些数据表明，头颈外科医生在常规随访中很少使用胸部X光以外的补充检查。作者推测，常规胸部X光检查可能对筛查第二原发性癌有价值。食管肿瘤的筛查技术仍存在争议。
