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Evaluation of Optimal Assessment Schedules for Surveillance After Definitive Locoregional Treatment of Locally Advanced Head and Neck Cancer: A Retrospective Cohort Study With Parametric Modeling of Event-Free Survival.
- Source :
-
JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2022 Nov 01; Vol. 148 (11), pp. 1059-1067. - Publication Year :
- 2022
-
Abstract
- Importance: In clinical practice, assessment schedules are often arbitrarily determined after definitive treatment of head and neck cancer (HNC), producing heterogeneous and inconsistent surveillance plans.<br />Objective: To establish an optimal assessment schedule for patients with definitively treated locally advanced HNC, stratified by the primary subsite and HPV status, using a parametric model of standardized event-free survival curves.<br />Design, Setting, and Participants: This was a retrospective study including 2 tertiary referral hospitals and a total of 673 patients with definitive locoregional treatment of locally advanced HNC (227 patients with nasopharyngeal cancer [NPC]; 237 patients with human papillomavirus-positive oropharyngeal cancer [HPV+ OPC]; 47 patients with HPV-negative [HPV-] OPC; 65 patients with hypopharyngeal cancer [HPC]; and 97 patients with laryngeal cancer [LC]). Patients had received primary treatment in 2008 through 2019. The median (range) follow-up duration was 57.8 (6.4-158.1) months. Data analyses were performed from April to October 2021.<br />Main Outcomes and Measures: Tumor recurrence and secondary malignant neoplasms. Event-free survival was defined as the period from the end of treatment to occurrence of any event. Event-free survival curves were estimated using a piecewise exponential model and divided into 3 phases of regular follow-up. A 5% event rate criterion determined optimal follow-up time point and interval.<br />Results: The median (range) age of the 673 patients at HNC diagnosis was 58 (15-83) years; 555 (82.5%) were men; race and ethnicity were not considered. The event rates of NPC, HPV+ OPC, HPV- OPC, HPC, and LC were 18.9% (43 of 227), 14.8% (35 of 237), 36.2% (17 of 47), 44.6% (29 of 65), and 30.9% (30 of 97), respectively. Parametric modeling demonstrated optimal follow-up intervals for HPC, LC, and NPC, respectively, every 2.1, 3.2, and 6.1 months; 3.7, 5.6, and 10.8 months; and 9.1, 13.8, and 26.5 months until 16.5, 16.5 to 25.0, and 25.0 to 99.0 months posttreatment (open follow-up thereafter). For HPV- OPC, assessment was recommended every 2.7, 4.8, and 11.8 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. In contrast, HPV+ OPC optimal intervals were every 7.7, 13.7, and 33.7 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. Five, 4, 12, 15, and 10 follow-up visits were recommended for NPC, HPV+ OPC, HPV- OPC, HPC, and LC, respectively.<br />Conclusions and Relevance: This retrospective cohort study using parametric modeling suggests that the HNC assessment schedules should be patient tailored and evidence based to consider primary subsites and HPV status. Given limited health care resources and rising detection rates and costs of HNC, the guidelines offered by these findings could benefit patients and health systems and aid in developing future consensus guidelines.
- Subjects :
- Male
Humans
Middle Aged
Aged
Aged, 80 and over
Female
Retrospective Studies
Progression-Free Survival
Neoplasm Recurrence, Local therapy
Neoplasm Recurrence, Local complications
Survivors
Papillomavirus Infections complications
Papillomavirus Infections therapy
Papillomavirus Infections diagnosis
Nasopharyngeal Neoplasms complications
Oropharyngeal Neoplasms therapy
Head and Neck Neoplasms therapy
Head and Neck Neoplasms complications
Hypopharyngeal Neoplasms complications
Laryngeal Neoplasms therapy
Laryngeal Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 2168-619X
- Volume :
- 148
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- JAMA otolaryngology-- head & neck surgery
- Publication Type :
- Academic Journal
- Accession number :
- 36173618
- Full Text :
- https://doi.org/10.1001/jamaoto.2022.2561