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Posttreatment surveillance of squamous cell carcinoma of the head and neck

Nabil F Saba, MD, FACP
Section Editors
Marshall R Posner, MD
Bruce E Brockstein, MD
David M Brizel, MD
Marvin P Fried, MD, FACS
Deputy Editor
Michael E Ross, MD


Regular posttreatment follow-up is an essential part of the care of patients who are treated for squamous cell carcinoma of the head and neck.

The goals of posttreatment surveillance are the early detection of locoregional recurrences, distant metastases, or second primary malignancies, and evaluation for and management of treatment-related complications.

Posttreatment surveillance in patients with head and neck squamous cell cancer is reviewed here. An overview of the treatment of head and neck cancer is presented separately. (See "Overview of treatment for head and neck cancer".)


Recurrent disease and second primary malignancies — The rationale for surveillance is that early detection of either a recurrence or a second primary tumor allows for appropriate treatment and better functional and survival outcomes. However, controlled prospective data demonstrating a survival benefit for any follow-up strategy do not exist. Therefore, retrospective data and observational studies are used to guide surveillance recommendations.

Whether early detection of recurrent disease alters outcomes is uncertain. Routine surveillance has been associated with a survival benefit in some observational studies when patients diagnosed at routine follow-up were compared with those who presented with symptoms [1,2]. However, other studies have not observed a survival benefit from detecting asymptomatic recurrences [3-6]. One explanation for the lack of a survival benefit may be the high proportion of recurrences that are symptomatic. Other studies suggest that survival in patients with recurrent disease is determined primarily by the extent of prior disease, its therapy and time to recurrence, and the location of the recurrence [7]. A randomized controlled trial of no meaningful follow-up versus surveillance after head and neck cancer treatment is impossible due to ethical considerations.

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Literature review current through: Nov 2017. | This topic last updated: Sep 07, 2017.
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