Surveillance after treatment for head and neck cancer

Systematic follow-up protocols, often including regular imaging, are an essential component of posttreatment care for head and neck cancer, aimed at the early detection of disease relapse and mitigating treatment-related morbidity. However, there is no consensus on the optimal length of follow-up and the value of imaging in surveillance.

Most head and neck cancer recurrences occur within 1-2 years after treatment. After 2 years, the recurrence rate decreases significantly, and after 3 years, recurrences are infrequent. Most of the recent studies suggest that prolonged scheduled follow-up programs are not necessary, as asymptomatic salvageable late recurrences are rare. Imaging surveillance for the early detection of otherwise undetected recurrences is supported by many studies, although its impact on survival remains unclear.

Recent literature emphasizes intensive follow-up programs during 1-2 years, as well as patient education for self-observation of alarming symptoms. Prolonged surveillance programs after 2-3 years may not be effective in detecting asymptomatic recurrences. While personalized surveillance based on risk factors is suggested, a lack of strict evidence hampers stratification. Imaging may be of value in detecting early asymptomatic recurrences at least up to 2 years, but disagreement exists regarding its utility in improving survival.