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Head and Neck Surgery

Detecting Recurrence in HNC Patients: Clinical vs Radiologic Evaluation

Wednesday, October 4, 2023
10:36 AM - 10:42 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Pallavi P. Kulkarni, BS

    Medical Student
    Penn State University College of Medicine
    Hershey, PA, United States

    • Co-Author(s)

  • Brandon L. LaBarge, MD

    Resident
    Penn State Health Department of Otolaryngology- Head and Neck Surgery
    Hummelstown, PA, United States

    • Senior Author(s)

  • Neerav Goyal, MD MPH FACS

    Associate Professor; Division Chief Head and Neck Surgery; Vice Chair Patient Safety and Quality
    Penn State Milton S. Hershey Medical Center
    Hershey, PA, United States

    • Co-Author(s)

  • Vijay A. Patel, MD

    Associate Physician
    University of California San Diego
    San Diego, CA, United States

Disclosure(s):
Pallavi P. Kulkarni, BS: No relevant relationships to disclose.
Neerav Goyal, MD MPH FACS: No relevant relationships to disclose.
Vijay A. Patel, MD: No relevant relationships to disclose.
Introduction: Recurrence of head and neck cancer (HNC) most likely occurs during the first two years following treatment; post-treatment surveillance guidelines for patients have been outlined by the National Cancer Comprehensive Network. This study aims to characterize patients with clinical (CR) and radiologic (RR) recurrences following treatment of HNC to provide insight into surveillance practices.

Methods: A retrospective chart review from 2003-2017 was conducted at a tertiary care institution. Patients with a diagnosis of recurrent HNC were identified and were determined to have CR or RR. A non-blinded radiologist with knowledge of recurrence reviewed imaging to view evidence of recurrence, retrospectively. Demographics, primary cancer characteristics, treatment details, recurrence details were gathered from patient charts.

Results: Fifty patients were included: 62% (n=31) of patients had CR and 38% (n=19) had RR. Average ages for CR and RR were 59.4 +/- 11.75 and 60.37 +/- 10.88, respectively. 13% of CR and 26.3% of RR patients were female. The most common SEER site for both cohorts was the larynx. 71% CR and 85% RR patients had stage III/IV primary cancers. 77.4% CR and 89.5% RR patients had recurrence within the first 2 years of initial treatment. Prior to recurrence, 22.3% CR and 52.6% RR patients had undocumented or a lack of symptoms. Between the CR group and the RR group, average time between previous image and clinical recurrence was comparable at 4.95 +/- 3.67 months and 6.13 +/- 4.09 months, respectively (p=0.49). Most patients in the RR group (61.1%) and only 6.9% CR patients had spread to lymph nodes/metastasis at recurrence. Lastly, more than half (52%) of CR patients consistently had no findings on imaging, and retrospective review noted post-treatment obscuring or artifact.

Conclusions: Clinical examination remains essential for detecting recurrence. Surveillance imaging at scheduled time points may not be sufficient in detecting HNC recurrence. Imaging can supplement physical examination. Regular surveillance clinical visits may be necessary with a frequency dependent on stage and site of the primary HNC.