Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

Abstract

Introduction: Patients with NSCLC may be treated with curative intent, yet they remain at high risk of both disease recurrence and second primary lung cancer (SPLC) and increased risk of early death. Guidelines provide recommendations for follow-up, but there is little consensus, and review of available evidence is necessary. The use of a systematic follow-up strategy for the detection of disease recurrence or SPLC after curative-intent treatment of NSCLC may increase the proportion of patients available for retreatment and increase the survival of patients with surveillance detection. Methods:We performed a systematic review and metaanalysis of prospective studies on follow-up of NSCLC after curative-intent treatment to answer the following three questions: What is the effect of follow-up on detection of recurrence or SPLC? What is the effect of surveillance detection on curative-intent retreatment? What is the survival impact?Results: Recurrence or SPLC was observed in 17.8% to 71% of patients. Scheduled imaging-detected recurrence in 60% to 100% of cases, yet neither computed tomographybased (OR ¼ 2.31, 95% confidence interval [CI]: 0.27-19.49, p ¼ 0.44) nor positron emission tomographycomputed tomography-based follow-up (OR ¼ 1.431, 95% CI: 0.92-2.22, p ¼ 0.12) was statistically superior to standard follow-up strategies. Detection of disease recurrence/SPLC significantly increased the odds of curativeintent retreatment (OR ¼ 4.31; 95% CI: 2.10-8.84, p < 0.0001). Curative-intent retreatment prolonged survival in reported studies. Conclusions:The early detection of disease recurrence/ SPLC may increase the likelihood of curative-intent retreatment and prolong survival. There is a clear need for prospective randomized controlled studies of follow-up to confirm effectiveness of available follow-up modalities.

Use of [18F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography after Curative Treatment of Non-Small-Cell Lung Cancer Patients: A Nationwide Cohort Study

“…Consequently, guidelines recommend close surveillance after therapy to detect recurrence. Nonetheless, the optimal frequency and type of imaging are still contentious subjects due to a lack of high-quality prospective studies [3].…”

Clinical Value of Surveillance 18F-fluorodeoxyglucose PET/CT for Detecting Unsuspected Recurrence or Second Primary Cancer in Non-Small Cell Lung Cancer after Curative Therapy

“…A considerable number of studies demonstrated the diagnostic usefulness of PET/CT in patients with suspected NSCLC recurrence [9,10]. However, the utility of FDG PET/CT surveillance in detecting recurrent lesions in NSCLC patients without any clinical symptoms or other abnormal imaging findings has not been established [11]. While some previous studies reported an excellent diagnostic performance of 96-97% for FDG PET/CT surveillance [12,13], others failed to demonstrate its improved diagnostic efficacy compared to conventional imaging [14,15].…”

Evaluating information loss in the National Cancer Database from cases lost to follow‐up

“…This long‐term follow‐up mandate has contributed to an institutional burden. There are limited time and resources being allocated to assess patient vital status 10 years postdiagnosis, as clinical researchers shift away from a survival framework to a curative or recurrence framework 6–8 in this timeframe. Quantified estimates of CTR burden demonstrate that 12.4 full‐time equivalents are needed to accommodate the current work conducted at an average registry, with an estimate 20% of a single registrar's work week being spent on active and passive follow‐up 9,10 …”