SHORT COMMUNICATION Head and neck squamous cell cancers: need for an organised time-bound surveillance plan Rehan Kazi • Kapila Manikanthan • K. A. Pathak • Raghav C. Dwivedi Received: 21 June 2010 / Accepted: 25 August 2010 / Published online: 11 September 2010 Ó Springer-Verlag 2010 Abstract Optimal care of patients with head and neck squamous cell cancer (HNSCC) involves a pre-determined period of post-treatment follow-up for the detection of recurrent or persistent disease, metastases and second primaries at the earliest opportunity. There is little evi- dence in literature as to whether the surveillance schemes should be based on patient survival, quality of life or cost- adjusted parameters. This article aims at highlighting some of the issues pertinent to the optimization of surveillance strategies in HNSCC. Keywords Head and neck cancer Á Head and neck squamous cell cancers Á Surveillance Á Follow-up Á Oral cancer Á Oropharyngeal cancer Á Laryngeal cancer Á Hypopharyngeal cancer Optimal care of patients with head and neck squamous cell cancer (HNSCC) involves a pre-determined period of post- treatment follow-up for the detection of recurrent or per- sistent disease, metastases and second primaries at the earliest opportunity. The timely identification of disease can help in the early institution of appropriate treatment with curative intent. In addition, surveillance is crucial for a complete rehabilitation and good quality of life of the patient [1]. In literature, a varied frequency of follow-up visits and an array of investigations have been used and recommended by the clinicians and oncologists across the globe from time to time. These interventions and investi- gations have to be used in an effective and decisive manner for the detection of recurrent or residual disease [2]. There are a number of published recommendations on post-treatment follow-up of HNSCC patients. These rec- ommendations may be site specific or common to all sites (generic). The generic recommendations suggest 8–27 office visits and around 18 chest radiographs in all during the first 5 years post-treatment [3, 4]. There have been no randomised controlled trials comparing a definite follow- up strategy versus those having no follow-ups. The American Head and Neck Society (AHNS) in a publication in 1996 recommended an average of 28 office visits and five chest radiographs in the first 5 years post-treatment [5]. Additional diagnostic tests vary according to the tumour site. Practice care guidelines published in the European Journal of Surgical Oncology (EJSO) in 2001 for clinicians participating in the management of HNSCC advised a 4–6 week follow-up schedule in the first 2 years, 3-monthly follow-up for the third year, 6-monthly follow- up in years 4 and 5, and finally annual visits thereafter [6]. Routine follow-up or surveillance post-treatment is indispensable and the site and stage of the tumour deter- mine the length of the follow-up rather than the differen- tiation grade of the tumour or type of initial treatment [2]. Patients for whom a salvage treatment option exists should have a strict follow-up regimen for the first 3 years. In patients who have been treated by a combined modality, the focus should be more on providing care and support rather than on detecting recurrence [7]. There is an R. Kazi (&) Á R. C. Dwivedi Head and Neck Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK e-mail: rehan_kazi@yahoo.com K. Manikanthan ENT Department, Grant Medical College, B.R. Ambedkar Road, Byculla, Mumbai 8, India K. A. Pathak Head and Neck Surgical Oncologist, Cancer Care Manitoba, University of Manitoba, Winnipeg R3A1R9, Canada 123 Eur Arch Otorhinolaryngol (2010) 267:1969–1971 DOI 10.1007/s00405-010-1377-x