Does Intensive Follow-up Alter Outcome in Patients with Advanced Lung Cancer?

Benamore, Rachel; Shepherd, Frances A.; Leighl, Natasha B.; Pintilie, Melania; Patel, Milan; Feld, Ronald; Herman, Stephen J.

doi:10.1097/01.jto.0000263708.08332.76

Cited by 51 publications

(52 citation statements)

References 30 publications

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“…Benamore et al compared 40 stage III patients who underwent the INT 0139 and INT 1060 intergroup trials and received intense surveillance against 35 patients with the same stage followed by chest radiograph. Although more recurrences were detected in the trial group, there was no significant difference in overall survival ( p =0.67) [20]. A recent meta-analysis examined the effect of intensive surveillance on survival from several heterogeneous series [21].…”

Section: Commentmentioning

confidence: 99%

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

Lou

Sima

Rusch

et al. 2014

The Annals of Thoracic Surgery

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Background The benefits of screening for non-small cell lung cancer (NSCLC) have been established for high-risk individuals, and recent guidelines advocate continued surveillance after curative therapy. Yet the optimal posttreatment surveillance strategy remains to be determined. We compared patterns of recurrence and modes of detection in surgically treated patients with pathologic early-stage and locally advanced NSCLC. Methods Consecutive patients who had undergone resection for stage I-IIIA NSCLC from 2004 to 2009 were identified from a prospectively maintained institutional database. All patients received interval chest computed tomography (CT) scans every 6 to 12 months after treatment. Results In total, 1640 patients were identified: 181 of 346 patients with stage IIIA NSCLC (52%) and 257 of 1294 patients with stage I-II NSCLC (20%) developed recurrences. Surveillance CT scan detected asymptomatic recurrences in 157 stage I-II patients (61%) and 89 stage IIIA patients (49%) (p=0.045). Symptoms led to detection of recurrences more often in stage IIIA patients (73 [40%]) than in stage I-II patients (81 [32%]). Distant were more common in stage IIIA patients than in stage I-II patients (153 [85%] vs. 190 [74%]; p=0.01). In stage IIIA patients, the risk of recurrence was highest during the first 2 years after surgery, but it remained substantial into year 4. Conclusions Stage IIIA patients had fewer recurrences detected by surveillance CT, a higher rate of symptomatic presentation, a markedly higher risk of recurrence, and a higher propensity for distant recurrence. Surveillance strategies may need to account for stage-specific differences.

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Section: Commentmentioning

confidence: 99%

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

Lou

Sima

Rusch

et al. 2014

The Annals of Thoracic Surgery

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“…Nakamura et al 17 reported similar survival for stage I patients utilizing surveillance with CT and CXR vs. CXR alone. Benamore et al 15 found that, for stage IIB–III patients, follow-up with routine CT offered earlier detection of successive malignancy but did not result in improved survival, versus CXR. Virgo et al, 18 comparing ‘non-intensive’ vs. ‘intensive’ follow-up that included more frequent CT imaging, found that intensive follow-up did not improve survival.…”

Section: Discussionmentioning

confidence: 99%

Does the method of radiologic surveillance affect survival after resection of stage I non–small cell lung cancer?

Crabtree

Chen

Gierada

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objective Controversy persists regarding appropriate radiographic surveillance strategies following lung cancer resection. We compared the impact of surveillance CT scan (CT) vs. chest radiograph (CXR) in patients who underwent resection for stage I lung cancer. Methods A retrospective analysis was performed of all patients undergoing resection for pathologic stage I lung cancer from January 2000–April 2013. After resection, follow-up included routine history and physical exam in conjunction with CXR or CT at the discretion of the treating physician. Identification of successive lung malignancy (i.e. recurrence at any new site or new primary) and survival were recorded. Results There were 554 evaluable patients with 232 undergoing routine postoperative CT and 322 receiving routine CXR. Postoperative five-year survival was 67.8% in the CT group vs. 74.8% in the CXR group (p = 0.603). Successive lung malignancy was found in 27% (63/232) of patients undergoing CT vs. 22% (72/322) receiving CXR (p = 0.19). The mean time from surgery to diagnosis of successive malignancy was 1.93 years for CT vs. 2.56 years for CXR (p = 0.046). For the CT group, 41% (26/63) of successive malignancies were treated with curative intent vs. 40% (29/72) in the CXR group (p = 0.639). Cox-proportional hazard analysis indicated imaging modality (CT vs. CXR) was not associated with survival (p = 0.958). Conclusion Surveillance CT may result in earlier diagnosis of successive malignancy vs. CXR in stage I lung cancer, although no difference in survival was demonstrated. A randomized trial would help determine the impact of postoperative surveillance strategies on survival.

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“…14,16-18 Many patients with surveillance detected recurrent cancer will be eligible for secondary therapy with curative intent. 10,12,16,17,19-22 Data regarding the impact of surveillance on improved survival have been mixed however. At least one study has demonstrated improved 3-year survival following treatment of surveillance-detected recurrence of 31% compared to 13% for those detected by symptoms.…”

Section: Commentmentioning

confidence: 99%

“…10,12,21,24-27 Still others report no difference in overall survival for surveillance programs. 1728 …”

Section: Commentmentioning

confidence: 99%

Predictors of Imaging Surveillance for Surgically Treated Early-Stage Lung Cancer

Backhus

Farjah

Zeliadt

et al. 2014

The Annals of Thoracic Surgery

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Background Current guidelines recommend routine imaging surveillance for non-small cell lung cancer (NSCLC) patients following treatment. Little is known about surveillance patterns for surgically resected, early-stage lung cancer patients in the community-at-large. We sought to characterize surveillance patterns in a national cohort. Methods We conducted a retrospective study using Surveillance, Epidemiology, and End-Results (SEER)-Medicare database (1995-2010). Patients with stage I/II NSCLC treated with surgical resection were included. Our primary outcome was receipt of imaging between 4 and 8 months following surgery. Covariates included demographics and comorbidities. Results Chest radiography (CXR) was the most frequent initial modality (60%) followed by chest computerized tomography (CT) (25%). Positron emission tomography (PET) was least frequent as initial imaging modality (3%). A total of 13% of patients received no imaging within the initial surveillance period. Adherence to National Comprehensive Cancer Network (NCCN) guidelines for imaging by overall prevalence was 47% for receipt of CT, however rates of CT imaging increased over time from 28% to 61% (p<0.01). Reduced rates of CT imaging were associated with stage I disease and surgery as the sole treatment modality. Conclusions Imaging following definitive surgery for NSCLC predominantly utilizes CXR rather than CT. Most of this imaging is likely for surveillance and in that context, CXR has inferior detection rates for recurrence and detection of new cancers. Adherence to guideline recommended CT surveillance following surgery is poor, but the reason multifactorial. Efforts to improve adherence to imaging surveillance must be coupled with greater evidence demonstrating improved long-term outcomes.

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Does Intensive Follow-up Alter Outcome in Patients with Advanced Lung Cancer?

Abstract: In patients with locally advanced NSCLC, frequent cross-sectional imaging does not alter survival after combined modality therapy.

Cited by 51 publications

References 30 publications

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

Does the method of radiologic surveillance affect survival after resection of stage I non–small cell lung cancer?

Predictors of Imaging Surveillance for Surgically Treated Early-Stage Lung Cancer

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