Oral and oropharyngeal cancers together are the sixth most common malignancy in the world, with an increasing incidence of oral squamous cell carcinoma (OSCC). The recurrence rate of OSCC is reported to be approximately 10-26%. About two-thirds of all recurrent tumours occur within 2-3 years of initial treatment. Recurrent disease or subsequent metastasis within the first 18 months after primary surgical resection worsens the five year survival rate of patients by about 20.5%-27.6%. Whilst close follow up is suggested, recognising recurrent disease can be challenging partly due to anatomical distortion, fibrosis, bleeding, oedema, inflammation and possible infection. There is also no international consensus or guidelines on either clinical or radiological follow up with detailed post treatment protocols. This is an interesting paper from Germany; the authors attempt to establish an algorithm for follow up based on a review of the literature, existing guidelines and their institutional protocols. They recommend a follow up with clinical and radiological components. An initial CT is recommended six weeks postoperatively and then once every 12 weeks for the first six months alternating with clinical review only, every third month in year two, twice a year in year three and four and finally once in year five. This is a total of 10 CT scans over the five years. If there is any ambiguity a PET is ordered. Ultrasound has limitations of imaging deeper structures and while MRI as a modality is discussed, it is not part of the regular protocol. This is an interesting paper and reveals practice of medicine elsewhere. The follow up recommendations of the National Comprehensive Cancer Network (NCCN) guidelines for head and neck cancer are physical examination and history every 1-3 months for the first year every 2-6 months for the second year, every 4-8 months in years 3-5 and imaging in the first six months post treatment. The modality of imaging is not however specified. These are similar to NICE guidelines. It is an interesting viewpoint and well written paper.

Loco-regional recurrence after surgical treatment of oral squamous cell carcinoma: proposals for follow up imaging based on literature, national guidelines and institutional experience.
Loeffelbein DJ, Eiber M, Mayr P et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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