There is no consensus as to the duration and nature of follow up following surgical resection of lung cancer with the recent Cancer Council Australia Cancer Guidelines Wiki citing ‘limited… insufficient evidence to support a specific follow up model’. Current American guidelines state the evidence base is ‘weak and low quality’.
After post-operative follow up,typical practice involves computed tomography (CT) of the chest at six months for two years, then annually up to five years after resection, although there is wide variation in practice in across different countries and within Australia. Follow up is hospital based, with respiratory specialists or thoracic surgeons although, again, there is little evidence to support this practice, with studies demonstrating patient preference and comparable outcomes with nurse led follow up. Similarly, there is increasing interest in the role of primary care for surveillance post-cancer therapy.
After lobectomy, local reoccurrence is most common in the first two years with the risk of recurrence nearly two-fold higher in persistent smokers. In addition, patients with a previous lung cancer are at high risk of developing metachronous lung cancers at a rate of 1-5% per annum. Therefore, surveillance over the first 2-3 years is for recurrence, then for metachronous primaries.
A recent randomised study of 1775 individuals with NSCLC stages I to IIIa (in abstract form to date), comparing CXR or CT chest for follow up failed to demonstrate any overall survival difference. Data on sub-analysis for the stage 1 participants is awaited. CXR has been subsequently shown to be ineffective in identifying early stage lung cancer and should not be used. Low dose CT is likely to be comparable to standard CT for the identification of recurrence or new primary and the role of PET-CT is undefined.