头颈癌治疗后监测影像学的作用存在争议，支持决策的证据有限。旨在确定在完成放化疗后缓解的无症状头颈癌患者中监测影像学的使用。这是一项回顾性研究，对已对头颈癌初始治疗实现完全代谢反应的成年患者进行的比较有效性研究回顾，定义为使用实体瘤 PET 反应标准 (PERCIST) 量表进行明确的阴性正电子发射断层扫描 (PET) 扫描完成治疗的前 6 个月。回顾了 2014 年 1 月至 2022 年 6 月期间对新诊断的头颈部鳞状细胞癌完成确定性放射治疗（联合或不联合化疗）的 501 名连续患者的病历。监视成像的定义是通过计算机断层扫描获取 PET在没有任何临床可疑症状和/或检查结果的情况下，对头颈部进行断层扫描 (CT)、磁共振成像 (MRI) 或 CT 检查。对于其余患者，在对初始治疗达到完全代谢反应后，在观察性基础上进行后续监测，并通过病史采集和体检（包括内窥镜检查）进行常规随访。这种预期方法仅在出现临床可疑症状和/或体检结果时才进行影像学检查。局部区域控制、总生存期和无进展生存期基于分配到监测影像学或期待性管理队列。这项研究包括340 名患者（平均 [SD] 年龄，59 [10] 岁；201 名男性 [59%]；88 名拉丁裔患者 [26%]；145 名白人患者 [43%]）在此期间实现了完全代谢反应。接受影像学监测治疗的患者与预期治疗的患者在 3 年局部区域控制、总生存期、无进展生存期或无远处转移方面没有差异。在这项比较有效性研究中，基于影像学的监测未能改善与头颈癌初级放射治疗完成后看似缓解的患者的预期治疗结果相比。

The role of surveillance imaging after treatment for head and neck cancer is controversial and evidence to support decision-making is limited.To determine the use of surveillance imaging in asymptomatic patients with head and neck cancer in remission after completion of chemoradiation.This was a retrospective, comparative effectiveness research review of adult patients who had achieved a complete metabolic response to initial treatment for head and neck cancer as defined by having an unequivocally negative positron emission tomography (PET) scan using the PET response criteria in solid tumors (PERCIST) scale within the first 6 months of completing therapy. The medical records of 501 consecutive patients who completed definitive radiation therapy (with or without chemotherapy) for newly diagnosed squamous cell carcinoma of the head and neck between January 2014 and June 2022 were reviewed.Surveillance imaging was defined as the acquisition of a PET with computed tomography (CT), magnetic resonance imaging (MRI), or CT of the head and neck region in the absence of any clinically suspicious symptoms and/or examination findings. For remaining patients, subsequent surveillance after the achievement of a complete metabolic response to initial therapy was performed on an observational basis in the setting of routine follow-up using history-taking and physical examination, including endoscopy. This expectant approach led to imaging only in the presence of clinically suspicious symptoms and/or physical examination findings.Local-regional control, overall survival, and progression-free survival based on assignment to either the surveillance imaging or expectant management cohort.This study included 340 patients (mean [SD] age, 59 [10] years; 201 males [59%]; 88 Latino patients [26%]; 145 White patients [43%]) who achieved a complete metabolic response during this period. There was no difference in 3-year local-regional control, overall survival, progression-free survival, or freedom from distant metastasis between patients treated with surveillance imaging vs those treated expectantly.In this comparative effectiveness research, imaging-based surveillance failed to improve outcomes compared with expectant management for patients who were seemingly in remission after completion of primary radiation therapy for head and neck cancer.