TY - JOUR
T1 - Value of routine follow-up for recurrence detection after treatment with curative intent for laryngeal squamous cell carcinoma
AU - van de Weerd, Cecile
AU - Geurts, Sandra M.E.
AU - Vercoulen, Richard J.M.T.
AU - van Veggel, Inge H.F.
AU - Brands, Maria T.
AU - Marres, Henri A.M.
AU - Hermens, Rosella P.M.G.
AU - van Tol-Geerdink, Julia J.
AU - Kaanders, Johannes H.A.M.
AU - Takes, Robert P.
N1 - Funding Information:
Follow-up primarily aims to detect new disease manifestations early, such as local (LR) or regional recurrences (RR) and second primary tumours (SPT), enabling better treatment options and survival rates [7]. Other objectives include evaluating treatment response, monitoring treatment-related sequelae, facilitating rehabilitation, and providing psychosocial support [ 3–5,7].In summary, the best estimated asymptomatic LRR pick-up rate after LSCC treatment is 20 % in the first follow-up year. This number can only increase if follow-up intervals are significantly shortened. Also, most LRRs occurred within two years after treatment. Only three asymptomatic LRRs were detected after more than two years. Therefore, we advise a maximum of two years of routine follow-up for LSCC. Furthermore, the focus should be on patient education and support, enabling patients to recognize and act upon symptoms indicating relapse. This could lead to increased early LRR detection without unnecessarily burdening our patients and healthcare systems.
Publisher Copyright:
© 2023
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Introduction: The benefits of routine follow-up after treatment of primary laryngeal squamous cell carcinoma (LSCC) remain disputed. Guidelines worldwide are consensus-based, and evidence for specific subgroups is lacking. This study evaluates routine LSCC follow-up including flexible endoscopy for detecting locoregional recurrence (LRR). Methods: A retrospective cohort of 413 LSCC patients treated between 2006 and 2012 was analysed. The cumulative risk of LRR was calculated. Routine follow-up was evaluated by follow-up visit (routine or interval) at which LRR was detected, LRR treatment intent, and overall survival (OS). Analyses were stratified by early (I-II) and advanced (III-IV) TNM-stage. Results: There were 263 (64 %) patients with early-stage and 132 (32 %) patients with advanced-stage LSCC. One-, two- and five-year cumulative risks for LRR after early-stage LSCC were 8 %, 18 %, and 26 %. For advanced-stage LSCC, cumulative risks of LRR were 20 %, 30 %, and 35 %. Of all 69 LRRs after early-stage LSCC, 72 % were routine-detected, 81 % were symptomatic, and 90 % received curative-intent treatment. Of all 45 LRRs following advanced-stage LSCC, 42 % were routine-detected, 84 % were symptomatic, and 62 % received curative-intent treatment. Five-year OS of early-stage LSCC with routine-detected LRR was 70 %, and 72 % for interval-detection (log-rank-p = 0.91). Five-year OS of advanced-stage LSCC with routine-detected LRR was 37 %, and 18 % for interval-detection (log-rank-p = 0.06). Conclusions: Routine follow-up for detecting asymptomatic recurrences seems redundant for early-stage LSCC. After advanced-stage LSCC, no asymptomatic recurrences were detected beyond one year posttreatment despite regular follow-up. Emphasis should be on other follow-up aspects, such as psychosocial support, especially after one year posttreatment.
AB - Introduction: The benefits of routine follow-up after treatment of primary laryngeal squamous cell carcinoma (LSCC) remain disputed. Guidelines worldwide are consensus-based, and evidence for specific subgroups is lacking. This study evaluates routine LSCC follow-up including flexible endoscopy for detecting locoregional recurrence (LRR). Methods: A retrospective cohort of 413 LSCC patients treated between 2006 and 2012 was analysed. The cumulative risk of LRR was calculated. Routine follow-up was evaluated by follow-up visit (routine or interval) at which LRR was detected, LRR treatment intent, and overall survival (OS). Analyses were stratified by early (I-II) and advanced (III-IV) TNM-stage. Results: There were 263 (64 %) patients with early-stage and 132 (32 %) patients with advanced-stage LSCC. One-, two- and five-year cumulative risks for LRR after early-stage LSCC were 8 %, 18 %, and 26 %. For advanced-stage LSCC, cumulative risks of LRR were 20 %, 30 %, and 35 %. Of all 69 LRRs after early-stage LSCC, 72 % were routine-detected, 81 % were symptomatic, and 90 % received curative-intent treatment. Of all 45 LRRs following advanced-stage LSCC, 42 % were routine-detected, 84 % were symptomatic, and 62 % received curative-intent treatment. Five-year OS of early-stage LSCC with routine-detected LRR was 70 %, and 72 % for interval-detection (log-rank-p = 0.91). Five-year OS of advanced-stage LSCC with routine-detected LRR was 37 %, and 18 % for interval-detection (log-rank-p = 0.06). Conclusions: Routine follow-up for detecting asymptomatic recurrences seems redundant for early-stage LSCC. After advanced-stage LSCC, no asymptomatic recurrences were detected beyond one year posttreatment despite regular follow-up. Emphasis should be on other follow-up aspects, such as psychosocial support, especially after one year posttreatment.
KW - Head and neck cancer
KW - Laryngeal cancer
KW - Recurrence
KW - Routine follow-up
KW - Surveillance
U2 - 10.1016/j.ejso.2023.107304
DO - 10.1016/j.ejso.2023.107304
M3 - Article
SN - 0748-7983
VL - 50
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 1
M1 - 107304
ER -