Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts

Małgorzata Wierzbicka; Jarosław Markowski; Wioletta Pietruszewska; Paweł Burduk; Bogusław Mikaszewski; Marek Rogowski; Krzysztof Składowski; Piotr Milecki; Jacek Fijuth; Dariusz Jurkiewicz; Kazimierz Niemczyk; Adam Maciejczyk

doi:10.3389/fonc.2023.1298541

Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts

Front Oncol. 2023 Dec 12:13:1298541. doi: 10.3389/fonc.2023.1298541. eCollection 2023.

Authors

Affiliations

¹ Department of Otolaryngology, Regional Specialist Hospital Wroclaw, Research & Development Centre, Wroclaw, Poland.
² Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland.
³ Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland.
⁴ Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland.
⁵ Department of Otolaryngology Head Neck Oncology, Medical University of Lodz, Lodz, Poland.
⁶ Department of Otolaryngology Phoniatrics and Audiology, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
⁷ Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
⁸ Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
⁹ Radiation and Clinical Oncology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
¹⁰ Department of Radiotherapy I, The Greater Poland Cancer Centre, Poznan, Poland.
¹¹ Department of Radiation Therapy, Oncology Chair, Medical University of Lodz, Lodz, Poland.
¹² Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland.
¹³ Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland.
¹⁴ Department of Oncology, Wroclaw Medical University, Wroclaw, Poland.

Abstract

Summary: The algorithm of follow-up in patients with head and neck cancer (HNC) has been prepared by a board of Polish Head Neck and Oncology Experts. The aim of this research is to focus on the specificity of HNC monitoring, to review the current trends in follow-up, and to adapt the evidence-based medicine international standards to the capabilities of the local healthcare service.

Materials and methods: The first methodological step was to categorize HNCs according to the estimated risk of failure after the adequate first-line treatment and according to the possibility of effective salvage treatment, resulting in improved overall survival. The final method used in this work was to prepare an authors' original monitoring algorithm for HNC groups with a high, moderate, and low risk of recurrence in combination with a high or low probability of using an effective salvage.

Results: Four categories were established: Ia. low risk of recurrence + effective organ preservation feasible; Ib. low risk of recurrence + effective salvage feasible; II. moderate risk of recurrence + effective salvage feasible; III. high risk of recurrence + effective salvage feasible; and IV. high risk of recurrence + no effective salvage feasible. Follow-up visit consisting of 1. ENT examination + neck ultrasound, 2. imaging HN tests, 3. chest imaging, 4. blood tests, and 5. rehabilitation (speech and swallowing) was scheduled with a very different frequency, at the proposed monthly intervals, tailored to the needs of the group. The number of visits for individual groups varies from 1 to 8 in the first 2 years and from 1 to 17 in the entire 5-year monitoring period. Group IV has not been included in regular follow-up, visits on own initiative of the patient if symptomatic, or supportive care needs, having in mind that third-line therapy and immune checkpoint inhibitors are available.

Conclusion: Universal monitoring algorithm for HNC four groups with a high, moderate, and low risk of recurrence after the adequate treatment in combination with a high or low probability of using an effective salvage is an innovative approach to redeploying system resources and ensuring maximum benefit for patients with HNC.

Keywords: advancement; algorithm; follow-up; head and neck cancer; primary location; risk of failure; salvage.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research received an internal research grant from Medical University of Lodz, Poland (503/1-036-03/503-11-002).