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
...Re...
...recommendations apply to patients with...
...ould undergo surveillance imaging for re...
...uld undergo surveillance imaging for...
...cians should use a diagnostic ches...
...s should use a low dose screening ches...
...ould NOT use FDG-PET/CT as a surveillance...
...ging may be omitted in patients who are cli...
...cians should NOT use circulating bioma...
...NSCLC patients, clinicians should NOT use brain...
...ts who have undergone curative intent...