Head and Neck Imaging Surveillance Strategy for HPV-positive Oropharyngeal Carcinoma Following Definitive (Chemo)Radiotherapy.

Abstract

PURPOSE\nTo describe the utilization pattern of head and neck (HN) surveillance imaging and explore the optimal strategy for radiologic residual lymph node (LN) surveillance following definitive (chemo)radiotherapy (RT/CRT) in human papillomavirus (HPV)+ oropharyngeal carcinoma (OPC).\n\n\nMETHODS\nAll HPV+ OPC patients who completed RT/CRT from 2012-2015 were included. Schedule and rationale for post-treatment HN-CT/MRI were recorded. Imaging findings and oncologic outcomes were evaluated.\n\n\nRESULTS\nA total of 1036 scans in 412 patients were reviewed: 414 scans for first post-treatment response assessment and 622 scans for the following reasons: follow-up of radiologic residual LN(s) (293 scans/175 patients); local symptoms (227/146); other (17/16); unknown (85/66). Rate of scans with unstated reason varied significantly among clinicians (3-28%, p<0.001) and none of them yielded any positive imaging findings. First post-treatment scans identified 192 (47%) patients with radiologic residual LNs. Neck dissection (ND) was performed in 28 patients: 16 immediately (6/16 positive), 10 after one follow-up scan (2/10 positive), and 2 after 2nd follow-up scan (1/2 positive). Thirty patients had >2 consecutive follow-up scans at 2-3-month intervals, and none showed subsequent imaging progression or regional failure.\n\n\nCONCLUSIONS\nPattern of HN imaging utilization for surveillance varied significantly among clinicians. Imaging surveillance reduces the need for ND. However, routine HN-CT/MR surveillance without clinical symptoms/signs does not demonstrate proven value in identifying locoregional failure or toxicity. Radiologic residual LNs without adverse features are common. If two subsequent follow-up scans demonstrate stable/regressing radiologic residual LNs, clinical surveillance without further imaging appears to be safe in this population.