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Comment & Response
January 16, 2020

Surveillance Outcomes and Intensity of Salvage Therapy Among Human Papillomavirus–Associated Oropharyngeal Cancers

Author Affiliations
  • 1Whiteside Institute for Clinical Research, Department of Radiation Oncology, St Luke’s Hospital, Duluth, Minnesota
  • 2Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
JAMA Otolaryngol Head Neck Surg. Published online January 16, 2020. doi:10.1001/jamaoto.2019.4198

To the Editor We read with interest the report by Masroor et al,1 suggesting that among patients with human papillomavirus (HPV)-associated oropharyngeal cancers, National Comprehensive Cancer Network (NCCN)-recommended regular posttreatment clinical examinations did not detect recurrence or improve survival, compared with observation. Among the 22 of 233 study patients who had recurrent disease, the authors report that 10 were symptom directed and 11 were imaging detected, indicating that half of all recurrences were detected by imaging, which contradicts the NCCN’s statement that most recurrences are reported by the patient.2 Curiously, the authors report almost no data on the treatment or outcomes of these imaging-detected recurrences, which in other cancer settings are often less advanced and more amenable to aggressive salvage therapy compared with recurrences found based on patient symptoms. We are aware that the same group recently reported on the outcomes of posttreatment surveillance positron emission tomographic–computed tomographic (PET-CT) scans in this same cohort of 233 patients,3 which concluded that although an initial posttreatment PET-CT had an excellent negative predictive value, subsequent PET-CT surveillance purportedly had no clinical value, with no PET-CT scans leading to curative-intent salvage treatment.

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