Annual follow-up with 18FDG-PET/CT can improve survival, as compared to conventional follow-up, in patients with head and neck cancer, according to study results published in JAMA Network Open.

Researchers found that this survival benefit was driven by patients with advanced disease and those with oropharyngeal tumors.

This study included 782 patients with head and neck squamous cell carcinoma (HNSCC) who were treated with curative intent during 2006-2019. Their median age was 61 (range, 32-95) years, and 82.1% of patients were men.

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The most common tumor site was the oropharynx (35.3%), followed by the larynx (24.8%), oral cavity (21.6%), and hypopharynx (15.5%). Most patients had stage IV disease (55.2%), followed by stage I (17.8%), stage III (15.5%), and stage II (11.3%). Exactly half of patients underwent surgery, and half received radiotherapy.

The patients underwent 18FDG-PET/CT follow-up (n=497) or conventional follow-up (n=285). In both groups, follow-up included clinical examination every 2 months for the first year, every 3 months during year 2, and every 4 months during year 3, as well as imaging at 12 months, 24 months, and 36 months. Imaging consisted of chest CT in the conventional group and 18FDG-PET/CT in the other group.

Over 3 years of follow-up, 111 relapses occurred, of which 62 (55.9%) were detected by 18FDG-PET/CT in patients who were asymptomatic. The subclinical recurrence detection rate was 12.4% with 18FDG-PET/CT. Of all subclinical recurrences, 18FDG-PET/CT revealed 58.1% at the 12-month follow-up, 30.6% at 24 months, and 11.3% at 36 months.

Follow-up with 18FDG-PET/CT was significantly associated with a decreased likelihood of death when compared to conventional follow-up (adjusted odds ratio [aOR], 0.71; 95% CI, 0.57-0.88; P =.002). At 3 years, the overall survival (OS) rate was 72.5% with 18FDG-PET/CT and 64.3% with conventional follow-up.

When patients were stratified by stage, the survival benefit was found to be driven by advanced disease. In patients with stage III-IV disease, the 3-year OS rate was 68.5% with 18FDG-PET/CT and 55.4% with conventional follow-up (P <.001). In patients with stage I-II disease, the 3-year OS rate was similar between the groups — 84.5% with 18FDG-PET/CT and 79.4% with conventional follow-up (P =.72).

Patients with oropharyngeal tumors experienced a survival benefit with 18FDG-PET/CT follow-up. The 3-year OS rate was 69.9% in the 18FDG-PET/CT group and 60.5% in the conventional group (P =.04). There was no significant difference in survival for other primary tumor locations.

“[U]se of 18FDG-PET/CT in the standard annual CFU [clinical follow-up] of HNSCC was associated with a 3-year survival benefit, with a larger benefit for patients with advanced initial tumor stage (III-IV) and oropharyngeal disease,” the researchers concluded. “Prospective multicenter randomized studies are needed to investigate a causal relationship with survival and may help to define a follow-up schedule.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Leclère J-C, Clément C, Le Pennec R, et al. An intensive 18F-fludeoxyglucose–positron emission tomography with computed tomography–based strategy of follow-up in patients treated for head and neck squamous cell carcinoma who are clinically asymptomatic. JAMA Netw Open. Published online August 1, 2023. doi:10.1001/jamanetworkopen.2023.26654

This article originally appeared on Cancer Therapy Advisor