Purpose/Objective(s) 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 (q≤4 month) surveillance imaging. Methods 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 (Q≤4 month) chest computed tomography (CT) or positron emission tomography (PET/CT) for routine surveillance following CRT for at least one year or until progression or death. Radiographic findings and clinical interventions within the first year were identified. Results 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). 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. Conclusions 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.

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Post-mastectomy radiation therapy (PMRT) in node-negative (NO) patients is controversial, and current guidelines only recommend consideration in high-risk patients. Multiple retrospective studies have suggested that large tumor size, young age and pre-menopausal status, close margin status, and lymphovascular invasion (LVI) are associated with increased local-regional recurrence (LRR), as high as 40% for 3 or more risk factors (RFs). Furthermore, there is data to show benefit for PMRT in N0 triple-negative breast cancer (TNBC). The objective of this study was to utilize the National Cancer Database (NCDB) to determine how the type and quantity of high-risk features influences practice patterns of PMRT for early N0 breast cancer, and specifically for TNBC. Materials/Methods: Through the NCDB, we identified 60,371 women ages 18 and over diagnosed between 2010 and 2016 with cN0 invasive ductal carcinoma (IDC) who underwent margin-negative mastectomy with pathologic tumor size up to 5cm, and pN0. PMRT, was defined as externalbeam of a minimum of 40Gy to at least the chest wall (CW). Hormone receptor-positive patients underwent adjuvant hormonal therapy. We stratified patients into TNBC or non-TNBC. Results: For the 51,784 women with non-TNBC patients (median age 60 years), PMRT was given to 1.6% of women (70% CW, 30% CW + regional lymph nodes (RNI)). 2.5% of women ages 50 years and under received PMRT, as opposed to 1.3% above the age of 50. 3.7% of women with LVI received PMRT, as opposed to 1.4% without LVI. 3.3% of women with tumors between 2 and 5cm received PMRT, as opposed to 1.0% with tumors 2cm or smaller. 44%, 42%, 13%, and 2% of patients had 0, 1, 2, or 3 RFs, of whom, 0.7%, 1.5%, 4.5%, and 6.5% received PMRT, respectively. For the 8,587 women with TNBC (median age 58 years), 2.8% received PMRT (64% CW-only, 36% CW+RNI). 4.3% of women ages 50 years and under received PMRT, as opposed to 2.1% above 50. 5.2% of women with LVI received PMRT, as opposed to 2.4% without LVI. 5.0% of women with tumors between 2 and 5cm received PMRT, as opposed to 1.2% of women with tumors 2cm or smaller. 38%, 41%, 18%, and 3% of patients had 0, 1, 2, or 3 RFs, of whom, 0.9%, 2.6%, 6.3%, and 8.9% received PMRT, respectively. Each individual RF was more likely to be associated with PMRT than not having that RF(p<0.0001), and having more RFs increased the likelihood of PMRT (p Z 0.0055). Median follow-up was 41 months, and there was no difference in overall survival between PMRT and no PMRT groups (p Z 0.59). Conclusion: Data from the NCDB was used to show that women who have early-stage N0 IDC with more RFs are incrementally more likely to receive PMRT. However, despite existing data suggesting the LRR of up to 40% with multiple RFs, only a small fraction of these women receive PMRT. This remains consistent even for the TNBC subset, where more data exists supporting PMRT. Further studies are needed to be conducted on the potential benefit of PMRT, such as effect on LRR and overall survival.

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