Abstract 95P
Background
The optimal surveillance strategy in patients with resected non-small cell lung cancer (NSCLC) is unknown. Early detection of recurrences by intense imaging follow-up may improve survival and whole-body fluorine-18-deoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) might be the optimal imaging modality given its high accuracy in preoperative staging. However, the role of FDG-PET/CT during postoperative surveillance remains controversial.
Methods
Data from a single-center cohort of 205 patients with resected stage I-III NSCLC and FDG-PET/CT surveillance was retrospectively collected, and patterns of recurrence and secondary primary lung cancer (SPLC) analyzed. All patients had preoperative FDG-positive tumor lesions and regular follow-up imaging with at least one postoperative FDG-PET/CT.
Results
With a median follow-up time of 26.3 months (range, 4.1-60.6), the rate for recurrence and secondary primary lung cancer (SPLC) was 22% and 8%, respectively. Approximately half of patients with recurrences presented with possibly associated pulmonary or general symptoms. However, this was the case only in 18% of patients with SPLC. Overall, 83% of all recurrences, and 65% of SPLC were detected on FDG PET/CT. Secondary curative-intent treatment was possible in 37% of patients with recurrences and in all patients with SPLC. For patients who had secondary curative-intent treatment for recurrence, the 1- and 2-year recurrence-free survival rates were 63% [42%, 96%] and 53% [31%, 91%], respectively. Incidental FDG-positive PET/CT findings occurred in 25% of all patients, mostly infections (71%).
Conclusions
In our cohort of patients with resected stage I-III NSCLC, recurrence was identified in more than 80% of all cases in one of the standardized three PET/CTs performed as part of our follow-up imaging protocol during the first two years after resection. Nearly all patients with non-distant recurrence qualified for a second curatively intended treatment. Further studies are necessary to identify patients who might benefit from an even more intensive surveillance strategy.
Clinical trial identification
EKNZ 2020-2000; November 2nd, 2020.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.