Surveillance Practice Patterns after Curative Intent Therapy for Stage I Non-Small-Cell Lung Cancer in the Medicare Population

Erb, Christopher T.; Su, Kevin; Soulos, Pamela R.; Tanoue, L.T.; Gross, Cary P.

doi:10.1016/j.lungcan.2016.07.017

Cited by 20 publications

(22 citation statements)

References 67 publications

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“…Variability of surveillance in clinical practice is even greater, with adherence to guidelines often being quite poor. In a study of adherence to NCCN and ACCP guidelines, Erb et al utilized the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and found that only 61.4% of stage I NSCLC patients received guideline-adherent surveillance during the initial 2 years after treatment 14 . Poor adherence can be partially explained by the paucity of quality longitudinal data to inform best practice.…”

Section: Resultsmentioning

confidence: 99%

“…In the real world, patients and physicians often deviate from interval-based regimens (especially as time from primary treatment increases). Previous studies have documented remarkably low adherence to existing guideline-recommended surveillance regimens, approximating 60% 14 . Additionally, one must contend with several biases when quantifying surveillance in observational research.…”

Section: Resultsmentioning

confidence: 99%

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Imaging surveillance for surgically resected stage I non–small cell lung cancer: Is more always better?

Subramanian

Liu²,

Greenberg

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Routine surveillance imaging for patients with resected non-small cell lung cancer is standard for the detection of disease recurrence and new primary lung cancers. However, surveillance intensity varies widely in practice, and its impact on long-term outcomes is poorly understood. We hypothesized that surveillance intensity was not associated with 5-year overall survival in patients with resected stage I non-small cell lung cancer. Additionally, we examined patterns of recurrence and new primary lung cancer development. Methods: Cancer registrars at Commission on Cancer accredited institutions re-abstracted records to augment National Cancer Database patient data with information on comorbidities, imaging surveillance including intent and result of imaging, and recurrence (2007-2012). Pathologic stage I non-small cell lung cancer patients undergoing computed-tomography surveillance were placed into three imaging surveillance groups based on clinical practice guidelines: high intensity (3 month), moderate intensity (6 month), and low intensity (annual). Kaplan Meier analysis and Cox regression were used to compare overall survival among the three surveillance groups. Results: 2442 patients were identified, with 805 (33%), 1216 (50%), and 421 (17%) patients in the high, moderate, and low surveillance intensity groups, respectively. Five-year overall survival

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Imaging surveillance for surgically resected stage I non–small cell lung cancer: Is more always better?

Subramanian

Liu²,

Greenberg

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…28 Although not recommended in routine follow-up after SBRT, 18 F-FDG PET/CT is frequently performed alternately with CT. For example, a recent study found that less than two-thirds of patients had this monitoring in line with recommendations. 30 Given that no SUV max has exceeded the threshold of 5 in case of RP in this study, it is conceivable to propose a PET/CT scan in cases of doubt between tumour recurrence and RP on CT scan, which remains the reference for follow-up.…”

mentioning

confidence: 79%

Radiographic findings after stereotactic body radiation therapy for stage I non-small cell lung carcinomas: retrospective analysis of 90 patients

Menoux

Antoni

Santelmo³

et al. 2019

J Radiother Pract

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Aim: Stereotactic body radiation therapy for lung tumours can expose patients to radiation pneumonitis (RP) (<6 months after irradiation) and lung fibrosis (beyond 6 months). The aim of this study was to describe post-irradiation radiographics appearances. Materials and methods: This retrospective study of 90 patients with a stage I non-small cell lung carcinoma reports a detailed description of the computed tomography (CT) or positron emission tomography/CT changes that can be observed after treatment, according to modified Kimura score for RP and Koenig’s classification for fibrosis. This evaluation was realised at 1 month and then every 3–4 months, with a median follow-up of 35 months. Results: The most common radiological RP pattern was diffuse consolidation. It appears in a mean time of 4 months and reaches its maximum at 9 months after radiotherapy. Seventy-three per cent of the RP evolved to fibrosis. Most of these findings were encompassed in the 35 Gy isodose. Findings: Radiological parenchymal changes are frequent in the treatment region, which renders the tumour response monitoring by tumour size, particularly by response evaluation criteria in solid tumours, unsuitable.

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“…Thus, the combination of EMAF and clinical information could significantly improve the predictive performance for 3-year overall survival. Early-stage lung cancer patients are expected to have favorable clinical prognosis, although they actually have diverse survival outcomes ( 33 ), which may be due to timing for treatment after surgery ( 34 ). EMAF appears to identify a subset of early-stage patients with relatively poor prognosis, which may indicate an alternative preoperative chemotherapy or radiation strategy followed by surgery.…”

Section: Discussionmentioning

confidence: 99%

Mutant‑allele fraction heterogeneity is associated with non‑small cell lung cancer patient survival

et al. 2017

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Genetic intratumor heterogeneity is associated with tumor occurrence, development and overall outcome. The present study aims to explore the association between mutant-allele fraction (MAF) heterogeneity and patient overall survival in lung cancer. Somatic mutation data of 939 non-small cell lung cancer (NSCLC) cases were obtained from The Cancer Genome Atlas. Entropy-based mutation allele fraction (EMAF) score was used to describe the uncertainty of individual somatic mutation patterns and to further analyze the association with patient overall survival. Results indicated that association between EMAF and overall survival was significant in the discovery set [hazard ratio (H)R=1.62; 95% confidence interval (CI): 1.08–2.41; P=0.018] and replication set (HR=1.63; 95% CI: 1.11–2.37; P=0.011). In addition, EMAF was also significantly different in lung adenocarcinoma and squamous cell carcinoma. Furthermore, a significant difference was indicated in early-stage patients. Results from c-index analysis indicated that EMAF improved the model predictive performance on the 3-year survival beyond that of traditional clinical staging, particularly in early-stage patients. In conclusion, EMAF successfully reflected MAF heterogeneity among patients with NSCLC. Additionally, EMAF improved the predictive performance in early-stage patient prognosis beyond that of traditional clinical staging. In clinical application, EMAF appears to identify a subset of early-stage patients with a poor prognosis and therefore may help inform clinical decisions regarding the application of chemotherapy after surgery.

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Surveillance Practice Patterns after Curative Intent Therapy for Stage I Non-Small-Cell Lung Cancer in the Medicare Population

Cited by 20 publications

References 67 publications

Imaging surveillance for surgically resected stage I non–small cell lung cancer: Is more always better?

Imaging surveillance for surgically resected stage I non–small cell lung cancer: Is more always better?

Radiographic findings after stereotactic body radiation therapy for stage I non-small cell lung carcinomas: retrospective analysis of 90 patients

Mutant‑allele fraction heterogeneity is associated with non‑small cell lung cancer patient survival

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