Narrow Band Imaging Versus White Light: No Superiority in Detecting Recurrences After Chemo/Radiation for HNSCC

"Detection rates were similar between the two methods (WL-NBI: 11.7%, WL: 10.0%), and NBI did not improve survival outcomes. Both overall survival and disease-free survival remained comparable, reinforcing WL as a reliable tool for routine post-treatment surveillance," the researchers reported in Clinical Otolaryngology.

Early detection of local recurrences in head and neck squamous cell carcinoma (HNSCC) plays a vital role in improving long-term survival. Flexible laryngoscopy is widely used for post-treatment surveillance, with white light being the standard imaging technique. Narrow-band imaging (NBI), which enhances mucosal and vascular contrast, has been proposed as a potentially superior method for identifying recurrent tumors.

Against the above background, Constanze Scholman, Department of Otorhinolaryngology – Head & Neck Surgery, the University of Groningen, University of Medical Center Groningen, Groningen, the Netherlands, and colleagues aimed to assess the effectiveness of white light (WL) and narrow-band imaging (NBI) during flexible laryngoscopy in detecting local recurrences and to evaluate their impact on clinical outcomes in patients with HNSCC who underwent radiotherapy with or without chemotherapy ((C)RT).

For this purpose, the researchers conducted a prospective randomized controlled trial at a tertiary head and neck oncologic center to evaluate the effectiveness of WL and NBI in detecting local recurrences after (chemo)radiotherapy ((C)RT) for HNSCC. A total of 257 patients without residual disease post-treatment were enrolled and randomly assigned to either the WL group (n=120) or the WL-NBI group (n=137). These patients were closely monitored for 24 months to assess recurrence patterns and survival outcomes.

The primary focus was to compare local recurrence rates between the two groups, while additional analyses examined overall survival, disease-specific survival, disease-free survival, and local recurrence-free survival.

Key Findings

• The detection rate of local recurrences was similar between both groups, with 11.7% in WL-NBI and 10.0% in WL.
• Overall survival was comparable, with 88.3% in the WL group and 87.6% in the WL-NBI group.
• Disease-specific survival rates were 86.7% for WL and 83.9% for WL-NBI, showing no significant difference.
• Disease-free survival remained similar between groups, with 85.0% in WL and 83.2% in WL-NBI.
• Local recurrence-free survival was 90.0% in the WL group and 89.1% in the WL-NBI group, with no observed superiority in the WL-NBI group.

The researchers found that the local recurrence rate in HNSCC patients without residual disease after (chemo)radiotherapy remained low during the first 24 months of follow-up. Their study demonstrated that flexible laryngoscopy using WL-NBI did not provide any added benefit in detecting local recurrences compared to standard white light imaging. Additionally, WL-NBI did not significantly impact clinical outcomes, reinforcing that white light remains an effective tool for routine surveillance.

"The findings suggest that there is currently no strong evidence to support the use of NBI as a superior imaging modality in post-treatment follow-up for HNSCC patients," the researchers concluded.

Reference:

Scholman, C., Westra, J. M., Zwakenberg, M. A., Wedman, J., M. Steenbakkers, J. H., Oosting, S. F., Halmos, G. B., & C. Plaat, B. E. Comparison of White Light With Narrow Band Imaging Using Flexible Laryngoscopy for the Detection of Local Recurrences After (Chemo)Radiation for Pharyngeal or Laryngeal Cancer: A Randomised Controlled Trial. Clinical Otolaryngology. https://doi.org/10.1111/coa.14293