OncoLink en espanõl
Share
Ask the Experts Archive > Types of Cancer > Lung Cancers > Non Small-Cell Lung Cancer
Follow Up for Stage IIIA NSCLC
Affiliation: Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 5, 2006
Dear OncoLink "Ask The Experts,"
After therapy for stage IIIA NSCLC, my doctors said we would do follow up chest x-rays every 3 months for the next 2 years, and then twice a year for 3 years. I questioned why they would not do CT and or PET scans, and I was told that if metastasis is discovered, it would not change the result or the amount of time I would ultimately survive, regardless of how it is discovered. I was told waiting for symptoms will have the same net result and progression timeline as if it were discovered via CT/PET. I would think the earlier metastasis is discovered and treatment begun, the more time I will have to slow or delay the progression.
For patients in remission from NSCLC staged 3A or less, with no other symptoms, what follow up tests do you normally order and with what frequency? Do you agree with the waiting for metastases approach?
Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of Pennsylvania, responds:
Unfortunately, there is no straightforward answer for this. There are two places where oncologists look for guidelines. They are the National Guideline Clearinghouse and the National Comprehensive Cancer Network. Both groups have similar recommendations for lung cancer patients who have been treated with curative intent therapy (as in your case): surveillance with a medical history, physical examination, and imaging study (either chest radiograph or chest computed tomography [CT] scan) is recommended every 4-6 months for 2 years, and then annually. Patients should be counseled on symptom recognition and should be advised to contact their physician if worrisome symptoms are recognized.
Both groups also "grade" the level of evidence, or proof, for their guidelines. The National Guidelines Clearinghouse rates the level of evidence as ?poor", while the NCCN admits that although there is not evidence from clinical trials to support it, there is agreement amongst experts that this is the best monitoring plan.
The issue addressed by your physicians is that if you detect metastases in someone who has undergone treatment with curative intent, then it is most unlikely that the patient will ever be cured with any form of therapy, except in the very rare situation where there is a single site of metastatic disease which can be surgically resected. You are correct that a CT and/or a PET scan are more sensitive than a plain chest X-ray in detecting recurrence or metastases, but they are also more expensive, a fact that must be considered when guidelines are developed. Neither guideline agency recommends following with PET scan. While we know that patients who develop metastases are unlikely to be cured, we don't know for sure whether earlier initiation of palliative therapy at detection of metastasis will improve outcome in survival time or quality of life, compared to waiting until the patient becomes more symptomatic.
Maybe the most important reason for careful follow up of lung cancer patients treated with curative intent is that they are always at risk for developing a second primary lung cancer. If a second primary is detected early, then the chance of cure is certainly increased.