A V de Visscher1, J J Manni. 1. Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Nijmegen, The Netherlands.
Abstract
OBJECTIVE: To evaluate whether additional curative treatment was possible in patients for whom routine long-term follow-up had led to the early detection of locoregional recurrence, distant metastases, and second primary tumors (events). DESIGN: Cohort study with a maximum follow-up of 126 months and a consensus questionnaire. SETTING: Department of Head and Neck Oncology at the University Hospital Nijmegen (the Netherlands). PATIENTS: There were 428 patients treated with curative intent for carcinoma of the larynx, pharynx, and oral cavity from 1979 to 1983. MAIN OUTCOME MEASURES: Site, stage, differentiation grade, and type of treatment of index tumor (routine follow-up vs self-referral). RESULTS: There were 205 patients (47.9%) who developed events, 76.1% within 3 years of initial treatment. Eighty-nine patients (43.4%) received curative treatment. The detection rate for events during routine follow-up (6350 appointments) was one in 34, and for self-referrals (54) it was one in 2.7; the cure rates were one in 78 and one in 6.8, respectively. The mean survival after detection of events with routine follow-up was significantly (P < .05) better than with self-referral (58 vs 32 months, respectively). CONCLUSIONS: Routine follow-up is indispensible. Site and stage of the index tumor played a part in the length of routine follow-up, in contrast to the differentiation grade or type of initial treatment. Yearly chest roentgenograms were valuable only for laryngeal index tumors. Patients considered routine follow-up important; however, negative findings at physical examination of complaints did not reassure all patients.
OBJECTIVE: To evaluate whether additional curative treatment was possible in patients for whom routine long-term follow-up had led to the early detection of locoregional recurrence, distant metastases, and second primary tumors (events). DESIGN: Cohort study with a maximum follow-up of 126 months and a consensus questionnaire. SETTING: Department of Head and Neck Oncology at the University Hospital Nijmegen (the Netherlands). PATIENTS: There were 428 patients treated with curative intent for carcinoma of the larynx, pharynx, and oral cavity from 1979 to 1983. MAIN OUTCOME MEASURES: Site, stage, differentiation grade, and type of treatment of index tumor (routine follow-up vs self-referral). RESULTS: There were 205 patients (47.9%) who developed events, 76.1% within 3 years of initial treatment. Eighty-nine patients (43.4%) received curative treatment. The detection rate for events during routine follow-up (6350 appointments) was one in 34, and for self-referrals (54) it was one in 2.7; the cure rates were one in 78 and one in 6.8, respectively. The mean survival after detection of events with routine follow-up was significantly (P < .05) better than with self-referral (58 vs 32 months, respectively). CONCLUSIONS: Routine follow-up is indispensible. Site and stage of the index tumor played a part in the length of routine follow-up, in contrast to the differentiation grade or type of initial treatment. Yearly chest roentgenograms were valuable only for laryngeal index tumors. Patients considered routine follow-up important; however, negative findings at physical examination of complaints did not reassure all patients.
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