Does intensive follow-up alter outcome in patients with advanced lung cancer?
BACKGROUND
Despite aggressive multimodality treatment, 5-year survival of stage III non-small cell lung cancer (NSCLC) remains <30%. To detect relapse, progression, or development of a second primary cancer early, many clinicians perform follow-up scans. To assess the impact of routine scanning, we compared clinical trial patients who had study-mandated scans with those treated off-study who had less intensive radiologic follow-up.


METHODS
The hospital cancer registry and trials databases were searched for patients with locally advanced NSCLC who had undergone multimodality treatment with curative intent. Baseline demographics were collected as well as frequency and results of clinical and radiologic follow-up.


RESULTS
Forty trial patients and 35 nontrial control patients were identified. Trial patients underwent significantly more imaging, particularly in the first 2 years (2.9 versus 2.0 body scans per year, p = 0.0016; 1.1 versus 0.4 brain scans per year, p < 0.001) but did not have more frequent follow-up visits. Forty-five cancers were detected (41 relapses, four metachronous primary tumors) in 44 (59%) patients. Of these, 28 (64%) sought medical attention that led to detection before a scheduled appointment or procedure. There was no significant difference in time to relapse or second primary in trial and nontrial patients (p = 0.80). Twenty-three patients had localized relapse, but only 15 could be treated with curative intent. Despite the trial group demonstrating a higher number of asymptomatic cancers and being offered potentially curative therapy more frequently, there was no significant difference in survival between trial and nontrial patients.


CONCLUSIONS
In patients with locally advanced NSCLC, frequent cross-sectional imaging does not alter survival after combined modality therapy.
Benamore
Rachel
R
Department of Radiology, University Health Network and University of Toronto, Toronto, Ontario, Canada. rachel.benamore@orh.nhs.uk
Shepherd
Frances A
FA
Leighl
Natasha
N
Pintilie
Melania
M
Patel
Milan
M
Feld
Ronald
R
Herman
Stephen
S
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000517:prevention & control*; D011336:Probability; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods