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P76 When Is It Safe To Discharge Resected Stage 1a/1b Nsclc From The Clinic?
  1. G Kamalatharan1,
  2. CS Moorcroft1,
  3. R Shah2,
  4. SCO Taggart3
  1. 1University of Manchester, Manchester, UK
  2. 2University Hospital of South Manchester, Manchester, UK
  3. 3Salford Royal NHS Foundation Trust, Salford, UK

Abstract

Introduction We have previously shown that the majority of recurrent disease occurs within the 2 years of lung cancer resection.1 Follow-up protocols vary between centres but often involve serial CXR examinations. At Salford we also perform a CT scan at one year after surgery. Given that the prognosis for early stage lung cancer is good, the question arises as to when it’s safe to discharge such patients from follow-up? Traditionally this has been set at 5 years.

The Salford Lung Cancer d-base provides comprehensive data on all patients in Salford undergoing surgical resection including outcomes during follow-up. To date, 255 patients have undergone resection of non-small cell lung cancer and the rate of resection is increasing year on year.2 This audit sets out to review the data following introduction of routine PET scans to our service in 2005 with a view to providing guidance as to when it might be safe to discontinue regular follow-up of early stage disease.

Methods All patients undergoing surgical resection were first identified from March 2006 to July 2010. Those with a post-operative stage 1A or 1B disease were then extracted; allowing a 4 year follow up for each patient. Those patients dying within 4 years of surgery from non-cancer and non-lung cancer causes were excluded to produce a selected cohort of patients. 1, 2, 3 and 4 years survival figures were then produced for each category of disease (1A, 1B and 1A+1B) to observe for any serial changes.

Results A total of 89 patients underwent surgical resection during the study period of which 55 (62%) were 1A or 1B disease. After exclusions, 43 patients (23 × 1A and 20 × 1B) were available for analysis. As expected, relapse rates were low and occurred in the first 2 years. Survival rates were high but remained stable after 2 years of follow up (see Table). The use of 1 year CT scans detected just 2 relapses.

Conclusions Allowing for the small numbers, the above audit supports a move away from traditional follow-up protocols to discharge alive and well patients with resected early stage disease from the clinic at 2 years. The role of imaging surveillance during the first 2 years requires further exploration.

References

  1. Tunney R et al. P195 Temporal Trends and Distribution of Recurrent Disease Following Lung Cancer Surgery and Relationship to Pre-Operative PET-CT. Thorax 2010;65:A159–A160

  2. Gornasa M et al. P7 Radical Treatments for Lung Cancer: Impact of Recent Service Improvements. Thorax 2013;68:A77–78

Abstract P76 Table 1

Patterns of survival for patients with 1A or 1B disease

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