The clinical benefit of routine PET/CT imaging in asymptomatic head and neck squamous cell cancer patients one year post-treatment

BACKGROUND: The incidence of head and neck cancer is increasing, creating a growing need for follow-up strategies. The benefit of routine PET imaging beyond six months after treatment in asymptomatic patients remains unclear. OBJECTIVE: To assess whether routine PET/CT or PET/MRI imaging one year after treatment improves survival in asymptomatic patients with HNSCC. MATERIALS AND METHODS: In this retrospective real-world cohort study, 590 asymptomatic HNSCC patients treated between 2010 and 2015 were included. All had achieved complete metabolic response on PET imaging 3-4 months after primary treatment. Patients underwent either routine PET imaging at one year (n=241) or no routine imaging (n=349). Primary endpoints were 5-year overall survival(OS) and disease-free survival(DFS). RESULTS: Routine imaging detected recurrence in 14 patients (5.8%). Eight of these were eligible for curative treatment, with a 2-year OS of 38%. However, routine PET imaging was not associated with improved 5-year OS (HR 0.73, 95% CI 0.50-1.05) or DFS (HR 0.98, 95% CI 0.68-1.43). No stage- or site-specific subgroup demonstrated a significant survival benefit. CONCLUSIONS: Although routine PET imaging identified some asymptomatic recurrences amenable to curative treatment, it did not improve long-term survival, questioning its value in routine follow-up of asymptomatic HNSCC patients.