Optimal post-treatment surveillance strategy for human papillomavirus-positive oropharyngeal cancer.

Abstract

The objective of the current study was to determine the optimal individualized surveillance strategies for human papillomavirus (HPV)-positive oropharyngeal cancer. A consecutive cohort of 1,146 HPV-positive oropharyngeal cancer patients treated by intensity-modulated radiation therapy between 2013 and 2023 was included. The primary endpoint was the power of detecting recurrence at each follow-up. Three distinct, stage-specific follow-up strategies were developed based on the monthly probability of disease recurrence. Over a 5-year post-treatment period, the total number of follow-up visits was 10, 11, and 12 for Stages I, II, and III, respectively. These risk-adapted follow-up strategies demonstrated superior detection efficiency when compared to existing clinical guidelines. Furthermore, validation using Markov decision-analytic models confirmed that the risk-based strategies were both more effective and cost-efficient than the guideline-recommended strategy. Compared to the surveillance strategies recommended by the clinical guidelines, our proposed approach for HPV-positive oropharyngeal cancer demonstrated greater cost-effectiveness.