Rationale Over 50% of patients undergoing surgery for lung cancer die from recurrence or a second episode of lung cancer within 5 yrs.1 There is little evidence based guidelines regarding the follow up of post surgical resection. Most follow up with physical examination and plain radiographs. Few recommend follow up with CTs. Within Mid Yorkshire NHS trust, patients are followed up post-operatively for 5 years. In the initial 2 years CTs are performed at 3, 12 and 24 months and chest radiographs at 3 to 6 monthly intervals for 5 years. The aim of this study was to assess the benefits of cross sectional imaging.
Methods A retrospective analysis was conducted of 109 patients undergoing surgery for lung cancer within Mid Yorkshire NHS hospital trust between 2009 and 2012.
Results 109 patients were included in total (42% female). Types of surgery were lobectomy (80%), wedge resection (10%) and pneumonectomy (10%) Recurrence occurred in 37% of patients (85% pulmonary).
60% of recurrences were adenocarcinomas and 33% squamous cell carcinomas. The majority of patients were asymptomatic (78%). Dyspnoea was the most frequent symptom (19%). The most commonly staged tumour was 1B (pT2A 53%, pN0 50%).
53% of recurrences were identified at the 3 month post-operative CT, 8% at 6 months, 28% at 12 months and 3% at 24 months. Chest radiographs identified recurrence at 6 (3%), 9 (3%) 18 (3%) and 21 months (3%). Total mortality within the recurrence group was 25%.
54% of patients had treatment with curative intent (surgery; 23% radiotherapy; 18% chemotherapy 8%; chemoradiotherapy 5%). 23% received palliative treatment, chemotherapy/ radiotherapy.
Conclusions There are substantial benefits of imaging in identifying recurrences in cancer patients. The post-operative CT imaging at 3 and 12 months is advantageous as they identified 53% and 28% of the recurrences respectively. However, the benefit of regular chest radiographs and surveillance CT at 24 months is questionable as they were less effective.
Egerman U, Jaeggi K, Habicht JM, Perruchoud AP, Dalugen P, Soler M. Regular follow-up after curative resection of nonsmall cell lung cancer: a real benefit for patients? Eur Respir J 2002 Mar;19(3):464–8