Recurrence detection in head and neck cancer: a systematic review of routine follow-up practices and clinical implications

INTRODUCTION: Worldwide, Head and Neck Cancer (HNC) follow-up guidelines are mostly consensus-based. The benefits of routine follow-up for early recurrence detection remain disputed. This systematic review examines recurrence detection and further management.

METHODS: PubMed, EMBASE, The Cochrane Library and Web of Science were searched for studies on recurrence diagnosis and management after curative-intent treatment of a primary carcinoma of the most common head and neck sites. Bias was assessed using the Risk of Bias In Non-randomised Studies of Interventions tool. Key outcomes included recurrence characteristics (frequency, localization, primary tumor stage), time to recurrence, diagnosis during routine or extra visits, symptoms, treatment intent and success, and survival.

RESULTS: A total of 48 studies were included: 12 were at moderate, and 36 at serious risk of bias. Fifteen studies reported that between 59 % and 100 % (mean: 77 %) of recurrences were diagnosed within two years posttreatment. The majority (mean: 72 %) were symptomatic. More than half were diagnosed at patient-initiated follow-up visits. No significant survival differences were found between symptomatic and asymptomatic patients or between recurrences diagnosed during routine versus extra visits.

CONCLUSIONS: Routine follow-up beyond two years for detecting asymptomatic recurrences is unlikely to significantly improve early diagnosis or survival. Potential downsides include anxiety prior to visits, societal costs, and burden on healthcare systems and ecosystems. Limiting routine follow-up to two years can be considered unless patients cannot be educated on recurrence-related symptoms. Ensuring accessible care in case of needs or symptoms is crucial.