Table 2 Post-treatment imaging of head and neck cancer beyond the first 3–6-month baseline imaging study. Overview of included studies evaluating the results obtained with routine imaging surveillance versus symptom-directed imaging and/or clinical finding-directed imaging

Imaging surveillance (at least once) after 3–6 months appears to be beneficial (in terms of lesion detection)

 Alnefaie 2022 [25]

RX/CT (lung)

• Nationwide cross-sectional survey

• Pulmonary screening is believed to be very effective or somewhat effective

 Ng 2020 [26]

mixed

• Markov decision process model

• For an infinite horizon policy, optimal scan intervals were between 10 and 18 months

 Gore 2020 [27]

CT/PET-CT

• Retrospective study including 255 patients

• Imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease (36% of all recurrences)

 Ng 2019 [28]

mixed

• Retrospective study including 1508 patients

• Disease recurrences were classified as either clinically detected or imaging-detected

• 20% of patients with locoregional recurrence and 60% of distant recurrences did not present with a clinical finding and were detected by imaging

• The yield of detecting a salvageable recurrence with routine imaging after 2 years in an asymptomatic patient with no adverse clinical findings is extremely low

 Iovoli 2018 [29]

CT (lung)

• Retrospective study including 1114 patients

• Routine surveillance for HNSCC patients with lung CT imaging had value

• Routine head and neck CT scans failed to identify any successfully salvaged patients

 Jackowska 2018 [30]

mixed

• Retrospective study including 438 patients

• Routine imaging studies detected 25.9% of recurrences

• 40.8% of recurrences were observed > 2 years after treatment

 Meregaglia 2018 [31]

mixed

• Decision-analytic Markov model

• An intensive follow-up (comprising imaging tests twice a year in the first 2 years) appears cost-effective

 Kim 2017 [32]

PET-CT

• Prospective study including 278 consecutive patients

• Posttreatment 18F-FDG PET/CT surveillance helped to properly detect recurrence and to predict survival

• Median time to recurrence was 10 months

 Kikuchi 2015 [33]

PET-CT

• Retrospective study including 158 patients

• 67% of tumor recurrences, including second primary cancers, were detected by routine surveillance with PET/ CT

• PET/CT after the second scan (i.e., > 6–12 months after treatment) may be less effective

 Jung 2014 [34]

CT/MRI/US

• Retrospective study including 520 patients

• 22.8% of recurrences were detected by screening imaging studies

 Dunsky 2013 [35]

PET-CT

• Retrospective study including 123 patients

• 8% of PET-CT surveillance scans showed asymptomatic recurrence, at an average interval of 35.7 weeks posttreatment

• Asymptomatic lesions were detected most frequently at distant sites

 Kim 2013 [36]

PET-CT

• Retrospective study including 143 patients

• PET/CT is a useful tool for the detection of recurrent tumors at 3–6 and 12 months after curative treatment

 Kostakoglu 2013 [37]

PET-CT

• Retrospective study including 99 patients

• FDG-PET/HRCT detected more disease recurrences or second primary cancers and did so earlier than CT or physical examination/endoscopy

 McDermott 2013 [38]

PET-CT

• Retrospective study including 512 patients

• A single PET/CT with negative findings carries a NPV of 91%, which is not adequate to defer further radiologic surveillance

• Two consecutive PET/CT examinations with negative findings within a 6-month period resulted in a NPV of 98%

 Paidpally 2013 [39]

PET-CT

• Retrospective study including 134 patients

• PET/CT performed between 4 and 24 months after treatment adds value to clinical assessment

 Beswick 2012 [40]

PET-CT

• Retrospective study including 388 patients

• For patients without clinical signs of recurrence, routine PET/CT surveillance beyond the first 24 months may be of limited value

 Abgral 2009 [41]

PET-CT

• Prospective study including 91 patients

• PET/CT is more accurate than conventional follow-up physical examination alone

• PET/CT could be proposed systematically at 12 months of the usual follow-up

 Lee 2007 [42]

PET-CT

• Retrospective study including 159 patients

• For routine surveillance, the initial PET scan should be performed within 6 months after completion of treatment

• The proper timing of next routine PET scan for subclinical patient with initial negative PET result might be 1 year after initial PET scan

Imaging surveillance after 3-6 m appears to have no or only limited benefit

 Iovoli 2018 [29]

CT

• Retrospective study including 534 patients

• Routine surveillance for HNSCC patients with lung CT imaging had value but routine head and neck CT scans failed to identify any successfully salvaged patients

 Ho 2013 [43]

PET-CT

• Retrospective study including 1114 patients

• HNC patients with negative 3-month imaging appear to derive limited benefit from subsequent PET/CT surveillance

 Sullivan 2010 [44]

CT

• Retrospective cohort study including 131 patients

• The utility of CT for surveillance may be limited

 Saussez 2007 [45]

RX/US/CT

• Retrospective cohort study including 195 patients

• Systematic head and neck US and CT exams revealed recurrent cancers with poor efficiency and should be performed only after clinical suspicion of recurrence

Imaging surveillance after 3-6 m is of uncertain benefit/other

 Zhang 2011 [46]

PET-CT

• Retrospective cohort study including 62 patients

• A negative initial posttreatment PET/CT result may have the potential to identify patients who are at very low risk of recurrence

• The HPV status may augment the predictive utility of an initial negative PET/CT result