Rapid recurrence in head and neck cancer: Underappreciated problem with poor outcome.

BACKGROUND: Rapid recurrence, defined as gross tumor recurrence after primary operation but prior to initiating postoperative radiation therapy (PORT), is underappreciated in head and neck cancer (HNC). METHODS: CT simulation images in patients with HNC managed surgically with adjuvant therapy at a single center between 2010 and 2017 were retrospectively reviewed. RESULTS: A total of 194 patients with HNC were included. Rapid recurrence occurred in 39 patients (20%) with a median time from operation to CT simulation of 37 days. On multivariable analysis (MVA), extranodal extension (ENE) was the only predictor of rapid recurrence (P = .03). While rapid recurrence, ENE, and perineural invasion were all associated with poor overall survival (OS) on MVA, rapid recurrence was the strongest predictor (hazard ratio [HR] 5.47). CONCLUSION: Rapid recurrence occurs at an underappreciated rate and is associated with poor survival outcomes. Patients with ENE are at highest risk and may benefit from diagnostic imaging evaluations immediately prior to PORT.

Imaging for head and neck cancer.

Imaging is an essential tool in the management of head and neck cancer. Oral, oropharyngeal, laryngeal, and hypopharyngeal lesions are initially imaged with computed tomography (CT) because it allows rapid image acquisition and reduces artifacts related to respiration and swallowing, which can degrade image quality and limit evaluation. Sinonasal, nasopharyngeal, and salivary gland tumors are better approached with MRI because it allows for better delineation of tumor extent. PET/CT is usually reserved for advanced disease to evaluate for distant metastatic disease and posttreatment residual and recurrent disease. Imaging is best used in combination with expert clinical and physical examination.