172P - Post-surgical follow-up for non-small cell lung carcinoma (NSCLC): Challenging current practice

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Non-Small-Cell Lung Cancer, Metastatic
Surgery and/or Radiotherapy of Cancer
Presenter Fahad Iqbal
Citation Annals of Oncology (2015) 26 (suppl_1): 51-54. 10.1093/annonc/mdv053
Authors F.M. Iqbal1, M. Haris1, I. Hussain1, S. Ghosh2
  • 1Respiratory Medicine, University Hospital of North Staffordshire, ST4 6QG - Stoke on Trent/UK
  • 2Cardiothoracic Surgery Department, University Hospital of North Staffordshire, ST4 6QG - Stoke on Trent/UK

Abstract

Aim/Background

Lung cancer has a poor survival rate. No reputable evidence-based guidelines on follow-up (intensity, imaging, and under which speciality) exist. We aimed to determine the benefit of post-surgical follow-up in patients treated for non-small cell lung carcinoma (NSCLC).

Methods

All patients with surgical resection, without chemotherapy, for NSCLC in 2010-2011 and follow-up at Royal Stoke Hospital (RSH) were included (n = 78). Current practice at RSH indicates post-surgery follow-up at: 6 weeks; 3, 6, 12, 24, 36, 48, and 60 months; a chest radiograph (CXR) performed on all visits apart from 6 weeks and 3 months.

Results

44/78 patients (56.4%) were followed-up by oncology 4 months (average) post-surgery. 9/78 followed-up post-surgery at 14 months by the respiratory team. Respiratory follow-up for 9/78 was done 12 months post-surgery and discharged shortly after. All patients followed-up <1 month by cardiothoracic surgeons (CTS) and at: 2-4, 5-7, 11-13 months and intermittently after with yearly follow-up. In total, 23/78 were discharged; 14/23 discharged by CTS ∼7 months post-surgery. To date, 17 recurrences were identified (table 1), 1/17 had CTS re-intervention without improvement in prognosis. Oncology followed patients monthly after referral for up to a year, after which follow-up was every 2-4 months. 7/23 were discharged from oncology 5.5 months post-surgery. CXRs were performed 1 month post-surgery with regular subsequent scans. Follow-up CT scans were performed after suspicious CXR findings or symptomatic presentation.  

Characteristics of recurrences

Variable Frequency
N 17
Gender m;f 8; 9
Smoker 7
Ex-smoker 10
Adenocarcinomas 10
Squamous cell carcinomas 5
Large cell carcinomas 2
Lobectomies 8
Pneumonectomies 2
Wedge resections 6
Other surgery 1
Recurrence site -local -brain -liver -adrenal 14/17 5/17 3/17 3/17

Conclusions

Recurrence was at (average) 21 months post-surgery. Recurrences were not detected at 3 months post-surgery; the usefulness of earlier visits and CXR should be questioned and may be eradicated. Further recurrence data is needed but immediate discharge by CTS post-operatively may be an option; the respiratory team could alternatively follow-up these patients.

Disclosure

All authors have declared no conflicts of interest.