Are Post-Treatment CT Scans Superior to Routine Examination for Patients With HNSCC?

05/22/18

A new study examined post-treatment evaluation methods of head and neck squamous cell carcinoma (HNSCC) in the context of advanced imaging and value-based care.

Currently, imaging guidelines recommend CT or PET scans to evaluate treatment response and detect residual disease after nonsurgical treatment of HNSCC. However, the utility of these diagnostic test have not been assessed against routine symptom and physical examination in regard to health resource utilization and cost of care considerations.

Thomas Hirsch, Medical College of Wisconsin (Milwaukee, WI), and colleagues conducted a study to objectively compare the utility of these diagnostic tests with that of routine history and physical examination. Researchers retrospectively reviewed an institutional cohort of 160 patients with HNSCC who underwent definitive radiation with or without chemotherapy from 2003 through 2014. All patients included in the study had post-treatment history, physical examination, and imaging data – including a 4-month PET scan.

Researchers calculated the sensitivity, specificity, negative-predictive, and positive-predictive values. Kaplan-Meier survival analyses were utilized for each symptom, physical examination, and imaging finding.

Results of the study will be presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting (June 1-5, 2018; Chicago, IL).

Researchers reported that physical examination and symptoms had higher specificity and lower sensitivity than imaging. While imaging showed good sensitivity and negative-predictive value, excess false positives led to poor specificity and positive-predictive value. Researchers noted that when physical examination and symptoms were evaluated together, performance was similar to both CT and PET imaging.

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Kaplan-Meier survival analysis showed that all physical examination/symptoms factors and PET response correlated with outcome, while baseline CT did not. No early interventions were recorded as a direct result of baseline CT scans.

“In an era of value-based care, a renewed emphasis on patient symptoms and physical examination findings may allow for improved resource utilization and cost of care,” researchers concluded. “These are strong predictors of residual disease in the immediate post-treatment setting, suggesting a need to reevaluate current imaging paradigms, particularly the utility of post-treatment CT scans.”—Zachary Bessette