Follow-up of the patient after curative treatment

The rationale for follow-up after curative treatment for lung cancer is to detect recurrences and new primary cancers early enough to allow retreatment with curative intent. However, there are no randomised data to support the hypothesis that followup after curative treatment for lung cancer improves survival. Several retrospective and prospective studies suggested that the detection of asymptomatic recurrences might improve survival after surgery for non-small cell lung cancer. Although a lead time bias cannot be eliminated, most guidelines recommend a history,physical examination and chest imaging (either chest X-ray or chest CT scan). Fiberoptic bronchoscopy has rarely been studied in this setting but might be of interest, particularly in squamous cell carcinoma. If performed, follow-up should ideally be maintained all life long. However, because most recurrences should be expected within 2 years after surgery, it is usually admitted that surveillance visits should be more frequent during this period. Frequency could decrease after 2 years, and again after 5 years. A large randomised study, the IFCT 0302 study, is ongoing in France. It compares 2 follow-up programs in completely resected stage I IIIa NSCLC, with overall survival as the end point. Patients are randomised between history + physical examination + chest X-ray and history + physical examination + chest X-ray + chest CT scan + fiberoptic bronchoscopy (optional for adenocarcinomas). After a radiotherapybased strategy, thoracic CT-scan has a poor discriminating capacity between recurrent tumour and post-treatment changes. PET-CT has been shown to be more accurate than CT after thoracic radiotherapy, especially if performed not earlier than 3 months after radiotherapy to avoid false-positive results due to post-radiotherapy inflammatory changes. PET-CT has been hypothesized to increase the proportion of recurrent diseases amenable for curative salvage treatment. A prospective evaluation suggested that PET-CT at 3 months after radiotherapy might be cost-effective, especially if only performed in asymptomatic patients.