Cross-sectional imaging remains the mainstay of posttreatment surveillance. Additionally, imaging in the posttreatment setting may be geared to detecting complications secondary to therapy, which include but are not limited to osteoradionecrosis, Assessment of Head and Neck Cancer infection, and flap failure. The appropriate imaging modality to evaluate each potential suspected complication will depend on the clinical scenario and is beyond the scope of this document. Radiography Chest CXR is not considered useful for the evaluation of pulmonary metastatic disease in treated cancer of the oral cavity or oropharynx or hypopharynx, or larynx or cancer of unknown primary of the head and neck. Chest CT is far more sensitive in detecting pulmonary metastatic disease compared to radiography [15], with the sensitivity of CXR to detect pulmonary metastatic disease reported as low as 28% compared to chest CT [11]. The low sensitivity may in part be due to the small size of pulmonary nodules at presentation or peripheral location, in which CXR tends to be less reliable [11]. The use of CXR for detection of metastases has not been shown to improve prognosis because pulmonary metastatic disease detected on CXR tends to be diagnosed at a late stage when it is not as amenable to treatment [18]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast in the evaluation of treated cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. CT Head With IV Contrast There is no relevant literature to support the use of CT head with IV contrast as follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the oral cavity, oropharynx, hypopharynx, larynx, or cancer of unknown primary of the head and neck.
Staging and Post Therapy Assessment of Head and Neck Cancer. Cross-sectional imaging remains the mainstay of posttreatment surveillance. Additionally, imaging in the posttreatment setting may be geared to detecting complications secondary to therapy, which include but are not limited to osteoradionecrosis, Assessment of Head and Neck Cancer infection, and flap failure. The appropriate imaging modality to evaluate each potential suspected complication will depend on the clinical scenario and is beyond the scope of this document. Radiography Chest CXR is not considered useful for the evaluation of pulmonary metastatic disease in treated cancer of the oral cavity or oropharynx or hypopharynx, or larynx or cancer of unknown primary of the head and neck. Chest CT is far more sensitive in detecting pulmonary metastatic disease compared to radiography [15], with the sensitivity of CXR to detect pulmonary metastatic disease reported as low as 28% compared to chest CT [11]. The low sensitivity may in part be due to the small size of pulmonary nodules at presentation or peripheral location, in which CXR tends to be less reliable [11]. The use of CXR for detection of metastases has not been shown to improve prognosis because pulmonary metastatic disease detected on CXR tends to be diagnosed at a late stage when it is not as amenable to treatment [18]. CT Chest Without and With IV Contrast There is no relevant literature to support the use of CT chest without and with IV contrast in the evaluation of treated cancer of the oral cavity or oropharynx or hypopharynx or larynx or cancer of unknown primary of the head and neck. CT Head With IV Contrast There is no relevant literature to support the use of CT head with IV contrast as follow-up imaging or evaluation of suspected or known recurrence of treated cancer of the oral cavity, oropharynx, hypopharynx, larynx, or cancer of unknown primary of the head and neck.