This audit based on 10 years of data held within the Salford Lung Cancer Team was designed to identify the temporal pattern and distribution of recurrent disease (RD) following surgery and how these may have been affected by the introduction of PET scanning to our service in 2004.
From 2000 to 2009, 118 lung cancer resections were carried out within our service with curative intent. 1 and 2-year survival rates (2000–2007) are 92/86% respectively for 1A/B disease, 88/59% for 2A/B and 86/57% for 3A. Thus far, 47 patients in the whole cohort (40%) have developed RD of which 35 (30%) have died. Rates for fatal recurrence by post-operative stage were 18.2% for 1A, 30.3% (1B), 27.3% (2A/B), 18.2% (3A) and 6% for 3B/1V.
The temporal pattern of RD revealed that the majority of recurrence occurred within 2 years after surgery; the cumulative recurrence rate was 38.7% at 1 year, 75.3% at 2 years and 86.6% by 3 years.
The distribution of RD revealed that the ratio of intra-thoracic to extra-thoracic metastasis was broadly similar (46%:54%, respectively). Extra-thoracic metastases developed in the Brain (17%), Bone (14%), Extra-thoracic Lymph nodes (7%), Liver (4%), Skin (3%), others (9%). The Abstract P195 Table 1 below sets out the relationship between the temporal pattern of recurrence and sites of metastasis.
Of note, in the cohort of patients with 2 years of follow-up from 2000 to 2007, rates of recurrence were similar in the 40 patients undergoing pre-operative PET scan (45%) versus the 39 patients having conventional CT staging (54%). Similarly, rates of RD were similar in both groups for intra-thoracic and extra-thoracic recurrence.
The peak incidence for RD after lung cancer surgery is within the first 2 years of follow-up. This is the time for intensive pro-active monitoring.
Pre-operative PET scans play an undoubted role in selecting patients for surgery but thus far in our service, they don't appear to be associated with significantly less RD because of the problem of microscopic metastases.
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