Value of routine follow-up for recurrence detection after treatment with curative intent for laryngeal squamous cell carcinoma

Cecile van de Weerd; Sandra M E Geurts; Richard J M T Vercoulen; Inge H F van Veggel; Maria T Brands; Henri A M Marres; Rosella P M G Hermens; Julia J van Tol-Geerdink; Johannes H A M Kaanders; Robert P Takes

doi:10.1016/j.ejso.2023.107304

Value of routine follow-up for recurrence detection after treatment with curative intent for laryngeal squamous cell carcinoma

Eur J Surg Oncol. 2024 Jan;50(1):107304. doi: 10.1016/j.ejso.2023.107304. Epub 2023 Nov 28.

Affiliations

¹ Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands. Electronic address: Cecile.vandeweerd@Radboudumc.nl.
² Maastricht University Medical Center, Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht, the Netherlands.
³ Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands.
⁴ Hospital Network Antwerp, Middelheim Medical Center, Department of Oral and Maxillofacial Surgery, Antwerp, Belgium.
⁵ Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, the Netherlands.
⁶ Radboud University Medical Center, Department of Radiation Oncology, Nijmegen, the Netherlands.

PMID: 38043360
DOI: 10.1016/j.ejso.2023.107304

Abstract

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.

Keywords: Head and neck cancer; Laryngeal cancer; Recurrence; Routine follow-up; Surveillance.

MeSH terms

Carcinoma, Squamous Cell* / diagnosis
Carcinoma, Squamous Cell* / therapy
Follow-Up Studies
Head and Neck Neoplasms*
Humans
Laryngeal Neoplasms* / diagnosis
Laryngeal Neoplasms* / surgery
Neoplasm Recurrence, Local / diagnosis
Prognosis
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck