3-year overall survival benefit of systematic follow-up with 18F-FDG PET/CT in asymptomatic patients treated for head and neck squamous cell carcinoma: a multicenter study

Abstract

Purpose

Patients diagnosed with head and neck squamous cell carcinoma (HNSCC) face a significant risk of locoregional recurrence within the first two years after treatment. While early detection of recurrence could potentially improve patient outcomes, the impact of such detection on survival remains uncertain. The aim was to assess the potential benefit of a systematic post-treatment follow-up strategy using 18 F-FDG PET/CT imaging on overall survival.

Methods

In this multicenter case-control study, patients were treated in two health areas from two different regions in France. All adults diagnosed with histologically confirmed HNSCC and treated between January 2017 and December 2020 with curative intent, with a complete response on imaging were included in the study. Primary endpoint was 3-year overall survival. The log-rank test was used to compare 3-year OS rates between the CFU (conventional follow-up) and PET/CT groups. A Cox regression model was used to assess the effect of the addition of 18 F-FDG PET/CT on survival outcomes.

Results

A total of 697 patients were included (534 males [77%], median age[IQR] 62[57–69] years); 508 patients had CFU and 189 patients had CFU + systematic annual 18 F-FDG PET/CT. Cox regression analysis showed a protective effect (OR = 0.56, 95%CI:0.397–0.795, p = 0.001) of systematic 18 F-FDG PET/CT. The 3-year OS in the PET/CT group was better than in the CFU group (83.5 ± 2.8% vs. 73.4 ± 2.1%, p = 0.008). The analysis based on stage showed a significantly better 3-year OS for advanced stage III/IV in the PET/CT group (n = 124) than in the CFU group (n = 312)(79.9 ± 3.7% vs. 71.5 ± 2.7%, p = 0.045) as well as for early stage I/II (90.5 ± 3.7% vs. 76.3 ± 3.2%, p = 0.047).

Conclusion

In this multicenter study, the use of 18 F-FDG PET/CT as an alternative to annual chest CT in the follow-up of head and neck squamous cell carcinoma (HNSCC) is associated to a survival benefit at 3 years.

Clinical trial number

Not applicable (retrospective study).