OBJECTIVE: To determine the predictive value of patient symptomatology and physical exam findings compared to routine surveillance MRI in detecting locoregional treatment failure following definitive chemoradiation in advanced-stage oropharyngeal carcinoma. METHODS: We identified patients with Stage III-IV oropharyngeal carcinoma who underwent chemoradiation therapy between April 2000 and September 2004 and underwent longitudinal follow-up care at our institution. Patient charts were retrospectively reviewed for findings on surveillance imaging, patient symptomatology and physical exam findings. Our outcome measurement was recurrent cancer. RESULTS: Forty patients received a total of 229 advanced radiographic surveillance studies over an average follow-up of three years, a mean of 5.6 studies per patient. Six patients experienced false-positive surveillance studies that resulted in intervention. Four patients experienced recurrent disease, two of whom had new symptoms or physical exam findings that preceded radiographic identification of disease. Surveillance studies identified recurrent disease in two asymptomatic patients who were salvaged, one of whom remains free of disease at follow-up. The overall sensitivity and specificity of the imaging surveillance program is 50 and 83 percent, respectively. CONCLUSION: In asymptomatic oropharyngeal cancer patients who have been treated with chemoradiation, a routine radiographic surveillance program produces limited opportunity for salvage and contributes to unnecessary morbid procedural investigations into disease recurrence. Patient symptomatology and routine physical examination may provide sufficient prognostic information regarding treatment failure.
ASJC Scopus subject areas