I’ve had a series of questions about how frequent follow-up should be for LC after surgery for early stage disease, or potentially after chemo and radiation for stage III disease.  The most appropriate answer to to say that there is really essentially no data on this subject, so people have made up guidelines based on little more than rationale and intuition.  As you’d expect with this basis, the guidelines have differed substantially.  One publication from the American College of Chest Physicians (ACCP) just came out on the subject (abstract here), in which they included a couple of tables to review the topic.

   First, the goals of follow-up are worth reviewing.  They basically include management of the acute side effects of the treatment, looking out for recurrent cancer, and surveillance for a new, different cancer. 

   We’ll go over things like the patterns of recurrence and the ability to treat recurrent cancer with curative intent, but it helps to start with the guidelines that have come out thus far.  They are listed in the chart below, from the recent ACCP publication (click on it to enlarge):

   The abbreviations are listed on the figure, but to highlight, the organizations are the Association of Community Cancer Centers (ACCC), the American College of Chest Physicians (ACCP), the American College of Radiology (ACR), American Society for Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and the National Comprehensive Cancer Network (NCCN).  The most interesting points to highlight is that they don’t agree on the specifics, but they all weigh heavily in favor of checking the patient history (any new symptoms?) and performing a physical exam looking for problems.  Several don’t even feature ANY imaging studies, some citing that there’s no evidence that a chest x-ray (CXR) or CT scan improve outcomes.  The only ones that highlight regular use of a CT scan are ACR and the NCCN.  Several others have guidelines that include NO regular imaging.  Not surprisingly, they all take into account that the risk of recurrence is greatest early on, so the rate of follow-up is highest in the first 2 years, then drops to rather minimal by five years out.

   I think many members will be surprised to find how minimal the recommended follow-up is, particularly in terms of imaging (no group recommends CT scans more than every 6 months, and NOBODY is recommending PET scans in the follow-up setting. 

   We’ll review some of the justification, or at least what little is known about recurrence risks and survivorship in some upcoming posts.