title: Clinical Impact of Frequent Surveillance Imaging in the First Year Following Chemoradiation for Locally Advanced Non-small-cell Lung Cancer.
abstract: Uncertainty exists regarding the optimal surveillance imaging schedule following definitive chemoradiation (CRT) for locally advanced non-small-cell lung cancer (LA-NSCLC) with regards to both frequency and modality. We sought to document the clinical impact of frequent (at least every 4 months) surveillance imaging.
  
  
  
  The records of all patients treated with CRT for stage IIIA/IIIB NSCLC between August 1999 and April 2014 were reviewed. Patients were included if they underwent frequent (at least every 4 months) chest computed tomography or positron emission tomography for routine surveillance following CRT for at least 1 year or until progression or death. Radiographic findings and clinical interventions within the first year were identified.
  
  
  
  We identified 145 patients with LA-NSCLC treated with CRT, 63 with eligible imaging. Median age was 63.6 years (range, 41.0-86.9 years). Asymptomatic recurrence was radiographically detected in 38 (60.3%). Twenty-one (33.3%) initiated systemic therapy. Two (3.2%) underwent definitive-intent treatment for isolated disease, including lobectomy for a histologically distinct primary NSCLC and stereotactic radiotherapy for an isolated recurrence, both of whom subsequently progressed. Eleven patients (17.5%) received no further therapy. Five patients (7.9%) underwent additional diagnostic procedures for false-positive findings.
  
  
  
  Frequent surveillance within the first year following CRT for LA-NSCLC lung cancer detects asymptomatic recurrence in a high proportion of patients. However, definitive-intent interventions were infrequent. The predominant benefit of frequent surveillance appears to be expedient initiation of palliative systemic therapy. Evidence-based algorithms for surveillance are needed, and should account for expected patient tolerance of and willingness to undergo additional cancer-directed therapies.
authors.affiliation: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Quoc-Anh
authors.initials: QA
authors.lastname: Ho
authors.affiliation: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Nima K
authors.initials: NK
authors.lastname: Harandi
authors.affiliation: Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA. Electronic address: medaly@ucdavis.edu.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Daly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000628:therapy*; D003952:Diagnostic Imaging; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010349:Patient Compliance
keywords: CRT; Computed tomography; NSCLC; Positron emission tomography; Relapse