Ho Quoc-Anh, Harandi Nima K, Daly Megan E
Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
Clin Lung Cancer. 2017 Jul;18(4):410-414. doi: 10.1016/j.cllc.2016.11.010. Epub 2016 Nov 21.
Uncertainty exists regarding the optimal surveillance imaging schedule following definitive chemoradiation (CRT) for locally advanced non-small-cell lung cancer (LA-NSCLC) with regards to both frequency and modality. We sought to document the clinical impact of frequent (at least every 4 months) surveillance imaging.
The records of all patients treated with CRT for stage IIIA/IIIB NSCLC between August 1999 and April 2014 were reviewed. Patients were included if they underwent frequent (at least every 4 months) chest computed tomography or positron emission tomography for routine surveillance following CRT for at least 1 year or until progression or death. Radiographic findings and clinical interventions within the first year were identified.
We identified 145 patients with LA-NSCLC treated with CRT, 63 with eligible imaging. Median age was 63.6 years (range, 41.0-86.9 years). Asymptomatic recurrence was radiographically detected in 38 (60.3%). Twenty-one (33.3%) initiated systemic therapy. Two (3.2%) underwent definitive-intent treatment for isolated disease, including lobectomy for a histologically distinct primary NSCLC and stereotactic radiotherapy for an isolated recurrence, both of whom subsequently progressed. Eleven patients (17.5%) received no further therapy. Five patients (7.9%) underwent additional diagnostic procedures for false-positive findings.
Frequent surveillance within the first year following CRT for LA-NSCLC lung cancer detects asymptomatic recurrence in a high proportion of patients. However, definitive-intent interventions were infrequent. The predominant benefit of frequent surveillance appears to be expedient initiation of palliative systemic therapy. Evidence-based algorithms for surveillance are needed, and should account for expected patient tolerance of and willingness to undergo additional cancer-directed therapies.
对于局部晚期非小细胞肺癌（LA-NSCLC）在进行根治性放化疗（CRT）后，关于最佳监测成像方案的频率和方式仍存在不确定性。我们试图记录频繁（至少每4个月一次）监测成像的临床影响。
回顾了1999年8月至2014年4月期间所有接受CRT治疗的IIIA/IIIB期NSCLC患者的记录。如果患者在CRT后接受了频繁（至少每4个月一次）的胸部计算机断层扫描或正电子发射断层扫描进行常规监测至少1年，或直至疾病进展或死亡，则纳入研究。确定了第一年的影像学检查结果和临床干预措施。
我们确定了145例接受CRT治疗的LA-NSCLC患者，其中63例有符合条件的成像检查。中位年龄为63.6岁（范围41.0 - 86.9岁）。影像学检查发现38例（60.3%）有无症状复发。21例（33.3%）开始全身治疗。2例（3.2%）对孤立性疾病进行了根治性治疗，包括对组织学上不同的原发性NSCLC进行肺叶切除术和对孤立性复发进行立体定向放射治疗，这两名患者随后均出现疾病进展。11例患者（17.5%）未接受进一步治疗。5例患者（7.9%）因假阳性结果接受了额外的诊断程序。
LA-NSCLC患者在CRT后的第一年进行频繁监测可在很大比例的患者中检测到无症状复发。然而，根治性干预并不常见。频繁监测的主要益处似乎是便于及时开始姑息性全身治疗。需要基于证据的监测算法，并且应考虑患者对额外癌症导向治疗的预期耐受性和接受意愿。
