Does Long-Term Surveillance Imaging Improve Survival in Patients Treated for Head and Neck Squamous Cell Carcinoma? A Systematic Review of the Current Evidence

BACKGROUND: Long-term posttreatment surveillance imaging algorithms for head and neck squamous cell carcinoma are not standardized due to debates over optimal surveillance strategy and efficacy. Consequently, current guidelines do not provide long-term surveillance imaging recommendations beyond 6 months.

PURPOSE: We performed a systematic review to evaluate the impact of long-term imaging surveillance (ie, imaging beyond 6 months following completion of treatment) on survival in patients treated definitively for head and neck squamous cell carcinoma.

DATA SOURCES: A search was conducted on PubMed, EMBASE, Scopus, the Cochrane Central Register of Controlled Trials, and the Web of Science for English literature published between 2003 and 2024 evaluating the impact of long-term surveillance imaging on survival in patients with head and neck squamous cell carcinoma.

STUDY SELECTION: We screened 718 abstracts and performed full-text review for 95 abstracts, with 2 articles meeting the inclusion criteria. The Risk of Bias in Non-Randomized Studies of Interventions assessment tool was used.

DATA ANALYSIS: A qualitative assessment without a pooled analysis was performed for the 2 studies meeting inclusion criteria.

DATA SYNTHESIS: No randomized prospective controlled trials were identified. Two retrospective 2-arm studies were included comparing long-term surveillance imaging with clinical surveillance and were each rated as having a moderate risk of bias. Each study included heterogeneous populations with variable risk profiles and imaging surveillance protocols. Both studies investigated the impact of long-term surveillance imaging on overall survival and came to different conclusions, with 1 study reporting a survival benefit for long-term surveillance imaging with FDG-PET/CT in patients with stage III or IV disease or an oropharyngeal primary tumor and the other study demonstrating no survival benefit.

LIMITATIONS: Limited heterogeneous retrospective data available precludes definitive conclusions on the impact of long-term surveillance imaging in head and neck squamous cell carcinoma.

CONCLUSIONS: There is insufficient quality evidence regarding the impact of long-term surveillance imaging on survival in patients treated definitively for head and neck squamous cell carcinoma. There is a lack of a standardized definition of long-term surveillance, variable surveillance protocols, and inconsistencies in results reporting, underscoring the need for a prospective multicenter registry assessing outcomes.