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Original Investigation |

Correlation Between Subjective Evaluation of Symptoms and Objective Findings in Early Recurrent Head and Neck Squamous Cell Carcinoma

Lluís Nisa, MD1; Riccardo La Macchia, MD1; Noureddine Boujelbene, MD2; Kishore Sandu, MD1; Kaouthar Khanfir, MD2; Roland Giger, MD1,3
[+] Author Affiliations
1Department of Otorhinolaryngology–Head and Neck Surgery, Hôpital de Sion, Centre Hospitalier du Centre du Valais/Réseau Santé Valais, Sion, Switzerland
2Department of Radiation Oncology, Hôpital de Sion, Centre Hospitalier du Centre du Valais/Réseau Santé Valais, Sion, Switzerland
3Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
JAMA Otolaryngol Head Neck Surg. 2013;139(7):687-693. doi:10.1001/jamaoto.2013.3289.
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Importance  This study addresses the value of patients’ reported symptoms as markers of tumor recurrence after definitive therapy for head and neck squamous cell carcinoma.

Objective  To evaluate the correlation between patients’ symptoms and objective findings in the diagnosis of local and/or regional recurrences of head and neck squamous cell carcinomas in the first 2 years of follow-up.

Design  Retrospective single-institution study of a prospectively collected database.

Setting  Regional hospital.

Participants  We reviewed the clinical records of patients treated for oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinomas between January 1, 2008, and December 31, 2009, with a minimum follow-up of 2 years.

Main Outcomes and Measures  Correlation between symptoms and oncologic status (recurrence vs remission) in the posttreatment period.

Results  Of the 101 patients included, 30 had recurrences. Pain, odynophagia, and dysphonia were independently correlated with recurrence (odds ratios, 16.07, 11.20, and 5.90, respectively; P < .001). New-onset symptoms had the best correlation with recurrences. Correlation was better between 6 to 12 and 18 to 21 months after therapy and in patients initially treated unimodally (P < .05). Primary stage and tumor site had no effect.

Conclusions and Relevance  The correlation between symptoms and oncologic status is low during substantial periods within the first 2 years of follow-up. New-onset symptoms, especially pain, odynophagia, or dysphonia, better correlate with tumor recurrence, especially in patients treated unimodally.

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Figures

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Figure 1.
Symptom Distribution During the First 2 Years After the End of Treatment
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Figure 2.
Flowchart of the Distribution of Symptom Intensity Variation in Groups With and Without Recurrence
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