Monitoring the No Evidence of Disease Patient and Multidisciplinary Collaboration

Dr. Zager outlines a monitoring strategy for the Case 1 patient who is NED following surgery and radiation. He recommends serial ultrasounds of regional lymph nodes and the parotid and cervical basins, combined with cross-sectional imaging (head/neck and chest). Initially, imaging every 4 months, transitioning to every 6 months and then annually as the patient demonstrates no recurrence over time.

Dr. Schoenfeld emphasizes that patients like this (ECOG 0, age 68 years) represent the minority of patients with cSCC, who are typically older with multiple comorbidities. He highlights the importance of ongoing collaboration between radiation oncology and medical oncology throughout the treatment course: communicating about patient recovery, radiation field details, post-treatment inflammation versus true disease, and readiness to begin adjuvant therapy. These ongoing communications help all providers interpret imaging accurately and ensure treatment continuity.

He acknowledges that establishing multidisciplinary networks can be challenging in community settings, and advocates for early communication pathways, noting that barriers around timing, particularly the 4 to 6 week window from surgery to radiation, are best addressed proactively. Dr. Singh adds that he personally provides his cell number to referring clinicians, reflecting that multidisciplinary care can take many forms in the real world.