What is your surveillance strategy for locally advanced HPV+ oropharynx cancer after PET CR?

1. PET scan at 12 weeks after chemoradiotherapy.
2. Endoscopic exam by ENT q 2-3 months in year 1; q 3-4 months in year 2; q 6 months in years 3-5. I reiterate time and again the importance of these in light of temporal pattern of local recurrence for HNSCC (usually in first 1-2 years).
3. If appreciate anything abnormal on endoscopic exam, or lymphadenopathy on physical exam (same frequency as above), order cross-sectional imaging of neck. Otherwise, I no longer order surveillance H&N imaging after initial post-treatment PET. 
4. In treated pts with continued tobacco dependence, or significant smoking hx, I order CT chest annually.

We looked at this question a few years ago (PMID: 26565997). Our conclusion was no further imaging unless clinical signs or symptoms after the 2 month CT or 3 month PET/CT, with clinical surveillance every 3 months to the 6 month time point, then every 6 months until 2 years, then yearly until 5 years.

This study showed excellent outcomes with 12 week PET surveillance for patients with p16 positive oropharyngeal cancer with locorgional control 90% plus.