Post Treatment Surveillance IFHNOS New York 2014 Michiel van den Brekel • Head and Neck Service • Netherlands Cancer Institute, Amsterdam William Carroll • George W Barber, Jr. Professor of Surgery • Section Head and Neck Oncology, University Alabama Birmingham
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Post Treatment SurveillanceIFHNOS New York 2014
Michiel van den Brekel• Head and Neck Service• Netherlands Cancer Institute,
Amsterdam
William Carroll• George W Barber, Jr. Professor of
Surgery• Section Head and Neck Oncology,
University Alabama Birmingham
Surveillance
• Different Perspectives– Patient– Doctor– Society– Oncologic
• Current Protocols, future perspectives
Patient perspective• Attention, security / being taken care
Ritoe, Cancer 2004402 patients with laryngeal cancer
• 4639 routine visits• in 2% of visits an asymptomatic recurrence was found• 224 events
• 83 local recurrence• 37 regional recurrences• 55 lung metastases / 2nd primaries (50% of DM are in fact 2nd primaries: Geurts et
al)• 27 HNSCC 2nd primaries
• In case of recurrences: still 35% survival !!
How Recurrences are Detected
No Difference in Survival
How Long ?• Ritoe (Larynx): 78% recurrences / 2nd primaries in first 3 years• Boysen (all sites): 76% of recurrences in first 2 years• De Visscher (all sites): 76% of recurrences and 2nd primaries in first 3 years• Lester: 95% of all evens in first
• 2.7 years for oropharynx• 2.3 years for hypopharynx• 4.7 years for larynx
Disease Specific Mortality for men (%)Current follow-up 33.6 14.7No follow-up 38.5 17.5Perfect follow-up 18.4 7.3
Published Guidelines
BAHNO NCCN ASHNS SHNS DHNS
Year 1 4–6 w 1–3 m 1–3 m 1–3 m 2 m
Year 2 4–6 w 2–4 m 2–4 m 2–4 m 3 m
Year 3 3 m 4–6 m 3–6 m 3–6 m 4 m
Year 4 6 m 4–6 m 4–6 m 4–6 m 6 m
Year 5 6 m 4–6 m 4–6 m 4–6 m 6 m
>Year 6 1 yr 6–12 m 1 yr 1 yr None
By courtesy of Prof. Remco de Bree
By courtesy of Prof. Remco de Bree
2004
By courtesy of Prof. Remco de Bree
By courtesy of Prof. Remco de Bree
NCCH Guidelines 2014
NCCH Guidelines 2014
2nd Primary Lung Cancer Screening
• 5-10% of surviving HNSCC develop pulmonary cancer
• US National Lung Screening Trial (NLST): 20% reduction in lung cancer mortality in high-risk cohort
• Dutch-Belgian lung cancer screening trial (NELSON):
– 7582 participants: 3 CT scans in 5.5 years » 458 (6%) positive screen results» 200 (2.6%) were diagnosed with lung cancer. » Positive screenings had a predictive value of 40.6%
(1.2% false-positive)» Survival benefit awaiting
Individualizing Surveillance• Length and intensity
– Between 3-5 year is optimal for HNSCC– Shorter than 3 months interval is not effective– Risk of locoregional recurrences versus
chances to effectively treat them• Smoking / alcohol / HPV• Tumor and treatment dependent
• In case effective options available and high risk recurrence: more frequent and vice versa.
Conclusions• Little evidence, possibly some survival advantage • Interval: less than 3 months very inefficient
– How long: 3-5 years– Modality: dependent on salvage/treatment