Lung Cancer Surveillance After Definitive Curative-Intent Therapy

Publication Date: December 12, 2019

Key Points

Key Points

Although patients with localized non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) are treated with intent to cure, the optimal surveillance of these patients for cancer recurrence and new primary lung cancers after potentially curative therapy is controversial.

Non-Small Cell Lung Cancer

The chance of NSCLC recurrence is greatest during the first 2 years following treatment with curative intent.

  • Patients with an intrathoracic recurrence may be salvaged with surgical resection, stereotactic body radiotherapy (SBRT) or chemoradiation depending on the clinical scenario.
  • Early identification of extra-thoracic metastatic recurrence may allow prompt molecular testing and facilitate the safe administration of precision palliative therapy before patients develop severe symptoms or deteriorate.

Two or more years after curative intent therapy, patients are at higher risk of developing a second primary lung cancer (1.5-2% per year) and may benefit from screening.


Small Cell Lung Cancer

During the first year after initial chemoradiation for SCLC, approximately 40% of patients with stage I-III (limited stage) will relapse. This increases to 60% during the 3 years post-treatment.
  • The risk of intracranial recurrence is significant. Therefore, close central nervous system (CNS) surveillance may afford treatment before permanent neurologic sequelae develop from symptomatic SCLC brain metastases.

Recommendations

...commendations

...ommendations apply to patients with curat...


...undergo surveillance imaging for recurrence...


...ld undergo surveillance imaging for de...


...inicians should use a diagnostic chest C...


...ians should use a low dose screening chest C...


...nicians should NOT use FDG-PET/CT as a su...


...e imaging may be omitted in patients...


...should NOT use circulating biomarkers as a...


...tage I-III NSCLC patients, clinicians shoul...


...atients who have undergone curative intent treatm...