Routine follow-up after laryngeal cancer treatment. The assessment of pre-symptomatic recurrence detection.
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RU Radboud Universiteit Nijmegen, 04 april 2007
Promotores : Marres, H.A.M., Verbeek, A.L.M. Co-promotor : Krabbe, P.F.M.
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SubjectUMCN 3.3: Neurosensory disorders
The principal goal of the follow-up program as formulated for patients with laryngeal carcinoma is the pre-symptomatic detection of local and regional recurrences. Different studies were conducted to evaluate the effectiviness of this follow-up protocol. The first study comprised 402 patients with squamous cell carcinoma of the larynx. In this cohort, 156 patients (39%) developed recurrent cancer. The maximum duration of follow-up was 10 years. More than 78% of all the above tumors developed during the first 3 years of follow-up. Analyses showed that there was no difference in the cancer-specific mortality or survival between patients with an asymptomatic and those with a symptomatic recurrence. A different study showed that there is no survival benefit by screening for primary lungcancer. Patients who have been treated by performance of a total laryngectomy do not have many therapeutic options left in case of recurrent cancer and should not be enrolled in the follow-up protocol. The main purpose of the routine follow-up examinations after the treatment of cancer is the detection of asymptomatic recurrences. However, the rate of asymptomatic detection turns out to be low, due especially to the short lead-time. On the basis of data from the literature and our own empirical data, we calculated the effect of different follow-up protocols: the current protocol, a protocol in which all follow-up examinations are abolished, and the 'perfect' follow-up protocol in which all tumors are detected in the asymptomatic phase. The results revealed that the number of routine follow-up examinations could well be reduced with only a slight negative effect on the life expectancy and cancer-specific mortality. It is recommended that the follow-up program be adjusted to the personal needs of the patient. Part of the follow-up examinations can be carried out by an oncology nurse. Following the treatment of laryngeal carcinoma, a follow-up duration of 3 years instead of 10 years would suffice.
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