It is customary to follow patients after a resection of primary non-small cell lung cancer (NSCLC) with regularly scheduled chest radiograph or chest CT. The value of this practice has been debated. We reviewed the outcome of patients followed in this manner to determine whether potentially curable recurrences or second primary lung cancers were detected.
Retrospective chart review of patients who underwent complete resection of NSCLC in 1997–1998 at MSKCC. Data included demographics, stage, types and frequency of radiographic studies used for surveillance, compliance with surveillance, diagnosis of recurrent and new primary lung cancers and subsequent interventions.
211 patients were included in the study: 131 with stages IA/B, 30 with stage IIA/B and 50 with stage IIIA. The general pattern of postoperative surveillance included chest radiograph or chest CT every 3 months during first year, every 4 months during second year, every 6 months during third year, and annually thereafter. Compliance with surveillance on a representative subset of 101 patients was 78%. 89 (42%) of the patients were diagnosed with recurrent or second primary tumor. Roughly half (44%) of these cancers were identified during scheduled surveillance – the remainder (56%) were identified due to symptoms. The likelihood of potentially curative intervention was influenced by stage at initial surgery and mode of detection (scheduled versus symptom-based assessment) of recurrent or second primary cancer. It was very rare (2%) for a patient with stage IIIA NSCLC at diagnosis to have a curable lesion discovered at follow-up.CONCLUSIONS: Routine surveillance after resection of a primary NSCLC appears to detect both curable recurrences and resectable second primaries. The benefit is less apparent in people with Stage IIIA disease at diagnosis.
Stage may be important for planning postoperative surveillance. The role of chest radiograph vs. chest CT, and the optimal interval of surveillance, both require further definition.
Assessment for recurrent and second primary tumors and subsequent intervention with curative intentAllStage IStage IIStage IIIARecurrent or 2nd primary89411236Symptom-driven assessment5021920- Curative intent treatment5 (10%)4 (19%)1 (11%)0 (0%)Scheduled assessment3920316- Curative intent treatment18 (46%)14 (70%)3 (100%)1 (6%)
Cancers detected by surveillance chest radiograph or chest CT and outcomeAllStage IStage IIStage IIIAChest CT2611213- Curative intent treatment7 (27%)9 (82%)2 (100%)0 (0%)Chest radiograph13913- Curative intent treatment7 (54%)5 (56%)1 (100%)1 (33%)
A.V. Bogolioubov, The LUNGevity Foundation, Grant monies.