Optimal Delivery of Follow-up Care Following Pulmonary Lobectomy for Lung Cancer

the ONA take:

In patients with non-small cell lung cancer (NSCLC) who have undergone pulmonary lobectomy, the specific follow-up schedule for CT imaging depends upon risk factors for recurrence, according to a review published in the journal Lung Cancer: Targets and Therapy.

Patients who have undergone complete resection for primary lung cancer typically require oncologic surveillance to detect disease recurrence or a second primary lung cancer so that an intervention can be initiated early to prolong survival and/or improve quality of life. Therefore, researchers sought to conduct a literature review of international recommendations and use both common clinicopathologic variables and uncommon risk factors for recurrence to determine the optimal delivery of follow-up care.

For the study, researchers compared guidelines for follow-up care after curative intent from the NCCN, NICE, ACCP, ESMO, and an international consensus statement, and found that they all differed in follow-up frequency, clinical evaluation, and medical modality. The investigators determined that low-dose CT imaging conducted annually, which results in less harm caused by radiation, may be continued beyond 3 years for patients who have no evidence of disease as these patients have an increased risk for developing a second primary malignancy and/or recurrence.

However, the specific follow-up schedule for CT imaging may be more or less frequent in patients who have undergone complete resection for NSCLC, depending upon risk factors for recurrence, such as performance status, disease-free interval, prior treatment, and metastatic sites.

Optimal Delivery of Follow-up Care Following Pulmonary Lobectomy for Lung Cancer
Optimal Delivery of Follow-up Care Following Pulmonary Lobectomy for Lung Cancer

Introduction: The rationale for oncologic surveillance following pulmonary lobectomy is to detect recurrent disease or a second primary lung cancer early enough so that an intervention can increase survival and/or improve quality of life. Therefore, we reviewed literature for international guidelines and reorganized these useful factors associated with non-small-cell lung cancer (NSCLC) recurrence as remedies in postoperative follow-up.
Method: The population of interest for this review was patients who had been treated with complete resection for primary NSCLC and were in follow-up.
Result: Guidelines on follow-up care for NSCLC vary internationally. Because of the production of progressive medical modalities, the current follow-up care should be corrected.
Conclusion: The specific follow-up schedule for computed tomography imaging may be more or less frequent, depending upon risk factors for recurrence. Many different predictors of postoperative recurrence may help to optimize the patient selection for specified surveillance guidelines and personalized adjuvant therapies to prevent possibly occult micrometastases and to get a better outcome.


Keywords: lung cancer, follow-up, surveillance, recurrence

INTRODUCTION

Lung cancer is the most commonly diagnosed cancer worldwide, with incidence rates continuing to increase in developing countries.1 Optimal follow-up care following pulmonary lobectomy for non-small-cell lung cancer (NSCLC) includes close surveillance for early detection of disease recurrence or second primary lung cancer and proper management for recurrence or second primary lung cancer. The majority of deaths in postresectional treatment of NSCLC are related to the development of recurrence.2,3 Close surveillance is required for survivors of lung cancer who have received definitive therapy but are at risk for recurrence of their disease and for the development of second primary lung cancers.4,5 There is a paucity of evidence for different follow-up strategies for patients with lung cancer as well as information about their cost effectiveness. International recommendations for follow-up after curative intent treatment for lung cancer are systematically reviewed comparing follow-up regimes in lung cancer.6 Multiple factors influence survival following disease recurrence. Risk factors of postoperative recurrence and/or metastatic disease in patients with NSCLC may enable us to optimize the patient selection for proper management with better outcome. However, few recent studies integrated the relationship of clinicopathologic variables and recurrence of NSCLC after pulmonary lobectomy in patients into the follow-up guiding principle. Therefore, we reviewed literature for international guidelines and reorganized these useful factors associated with NSCLC recurrence as remedies in postoperative follow-up.  

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