Symptom-based vs radiological follow-up in head and neck squamous cell carcinoma: A systematic review

Background: The optimal follow-up strategy for head and neck squamous cell carcinoma (HNSCC) remains uncertain, with inconsistent international guidelines regarding routine radiological surveillance. Methods: A systematic search of PubMed/MEDLINE, EMBASE, and CENTRAL (to April 2025) identified studies including adults with HNSCC undergoing different follow-up modalities. Primary outcomes were overall (OS) and disease-free survival (DFS); secondary outcomes included recurrence detection mode, salvageability, and diagnostic accuracy. Results: Eighteen retrospective studies met inclusion criteria. Most recurrences (61.5%) were symptom-detected, followed by clinical (24%) and imaging (14.5%) surveillance. Salvageable recurrences were more frequent in symptom-based (60%) than clinical (45%) or imaging (30%) strategies. Across eight studies with survival data, no significant OS or DFS differences emerged between radiological and non-radiological strategies. Conclusion: Available evidence does not demonstrate a survival advantage associated with routine radiological surveillance after curative treatment for HNSCC. and may be limited to symptomatic cases, inaccessible sites, or early post-treatment assessment.