Routine follow-up after surgical treatment of lung cancer: is chest CT useful?

Abstract

Objective: To report the experience of a routine follow-up program based on medical visits and chest CT. Methods: This was a retrospective study involving patients followed after complete surgical resection of non-small cell lung cancer between April of 2007 and December of 2015. The follow-up program consisted of clinical examination and chest CT. Each follow-up visit was classified as a routine or non-routine consultation, and patients were considered symptomatic or asymptomatic. The outcomes of the follow-up program were no evidence of cancer, recurrence, or second primary lung cancer. Results: The sample comprised 148 patients. The median time of follow-up was 40.1 months, and 74.3% of the patients underwent fewer chest CTs than those recommended in our follow-up program. Recurrence and second primary lung cancer were found in 17.6% and 11.5% of the patients, respectively. Recurrence was diagnosed in a routine medical consultation in 69.2% of the cases, 57.7% of the patients being asymptomatic. Second primary lung cancer was diagnosed in a routine medical appointment in 94.1% of the cases, 88.2% of the patients being asymptomatic. Of the 53 patients who presented with abnormalities on chest CT, 41 (77.3%) were diagnosed with cancer. Conclusion: Most of the cases of recurrence, especially those of second primary lung cancer, were confirmed by chest CT in asymptomatic patients, indicating the importance of a strict follow-up program that includes chest CTs after surgical resection of lung cancer.

A Graph-Based Approach to Identify Factors Contributing to Postoperative Lung Cancer Recurrence among Patients with Non-Small-Cell Lung Cancer

“…Based on the segmentation, volume and mean density (i.e., average Hounsfield (HU) value) were computed for each body tissue. (3) Tumor features based on dedicated chest CT scans: Lung tumors in the cohort were automatically segmented using our available algorithm [33], and 10 CT image features were quantified: (1) volume, (2) mean density, (3) surface area, (4) maximum diameter, (5) mean diameter, (6) solidness, (7) mean diameter of the solid part, (8) cavity ratio, (9) calcification volume, and (10) irregularity. We used a threshold of −300 HU to determine the solid component of a nodule.…”

“…However, even after successful surgical resection, the cancer recurrence rate remains alarmingly high, ranging from 30% to 55% [ 3 , 4 ], leading to poor outcomes [ 5 , 6 ]. Although follow-up computed tomography (CT) imaging after resection is crucial in identifying most cases of recurrence, current postoperative surveillance strategies do not consider individual risk factors beyond the pathologic stage [ 7 , 8 ]. Identifying additional preoperative factors that can influence postoperative cancer recurrence would allow for the better assessment of the likelihood of recurrence, which would be valuable in facilitating neoadjuvant and adjuvant therapy [ 9 , 10 ] to minimize recurrence and guiding initial follow-up treatment plans following surgical resection.…”