Lung Cancer Surveillance After Definitive Curative-Intent Therapy: ASCO Guideline

Abstract

PURPOSE To provide evidence-based recommendations to practicing clinicians on radiographic imaging and biomarker surveillance strategies after definitive curative-intent therapy in patients with stage I-III non–small-cell lung cancer (NSCLC) and SCLC. METHODS ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, radiology, primary care, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2019. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 14 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Patients should undergo surveillance imaging for recurrence every 6 months for 2 years and then annually for detection of new primary lung cancers. Chest computed tomography imaging is the optimal imaging modality for surveillance. Fluorodeoxyglucose positron emission tomography/computed tomography imaging should not be used as a surveillance tool. Surveillance imaging may not be offered to patients who are clinically unsuitable for or unwilling to accept further treatment. Age should not preclude surveillance imaging. Circulating biomarkers should not be used as a surveillance strategy for detection of recurrence. Brain magnetic resonance imaging should not be used for routine surveillance in stage I-III NSCLC but may be used every 3 months for the first year and every 6 months for the second year in patients with stage I-III small-cell lung cancer who have undergone curative-intent treatment.

Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

“…In relation to likely sites of recurrence, CT-based surveillance is currently embedded in available guidelines, including recommendations from the National Comprehensive Cancer Network, United States, suggesting chest CT every 6 months for 2 to 3 years after surgery, and every 3 to 6 months for 3 years after radiotherapy, 46 and similarly in recent American Society of Clinical Oncology guidelines. 47 Other guidelines are less prescriptive. The latest guidelines of the National Institute for Health and Care Excellence on lung cancer recommend to offer all people with lung cancer an initial specialist follow-up appointment within 6 weeks of completing treatment to discuss ongoing care with regular appointments after this rather than relying on the person requesting appointments when they experience symptoms and to offer protocol-driven follow-up.…”

Cost-Effectiveness of Surveillance Scanning Strategies after Curative Treatment of Non–Small-Cell Lung Cancer

“…Although the data vary on the impact of surveillance on OS, the assumptions are made that scanning causes no physical harm, and early detection must have some benefit on survival. 5 …”

“…40 Therefore, discounted costs and QALYs of all 108 strategies were analyzed in a PSA. [1][2][3][4][5] The distributions used in the PSA are provided in Table 1 for all model parameters. Most parameters remained the same as in the previous publications.…”

“…Current recommended intervals are the same for all guidelines, but the level of evidence remains low. [1][2][3][4][5] However, clinical practice still varies considerably. 6,7 Currently, the evidence for surveillance scanning is low.…”

Surveillance After Curative-Intent Treatment for NSCLC: More to It Than Meets the Eye

“…As a matter of fact, most guidelines recommend follow-up based on history and physical evaluation (HPE) and chest computed tomography (CT) scan is usually performed every 6 months for 2 years and then annually. [3][4][5] The systematic review by Stirling et al 6 published in this issue of the Journal of Thoracic Oncology provides a wonderful opportunity to reflect on our practice.…”