Patterns of follow-up care after curative radiotherapy ± chemotherapy for stage I-III non-small cell lung cancer

Objectives: To describe patterns of follow-up care for non-small cell lung cancer patients treated with curative radiotherapy and to evaluate the role of routine imaging.

Materials and methods: We retrospectively analyzed follow-up care of patients with stage I-III non-small cell lung cancer treated with curative radiotherapy (minimum dose of 50 Gy) between 2007 and 2011 at three Sydney institutions. Patient demographics, tumor characteristics and treatment factors were collected from oncology and hospital records. Follow-up visits were recorded until an event (recurrence or new primary) was diagnosed or censor date was reached (December 31, 2016). Univariate and multivariate analyses were performed to identify factors associated with subsequent curative treatment and survival.

Results: Two-hundred and eighty-three patients were identified with a median age of 72 (36-91) years. Median number of follow-up visits was 6, and median time to first event was 10.8 months. Follow-up visits were by routine appointment in 74%, and symptomatic presentation in 26%. Variation in follow-up was seen across the three institutions in terms of imaging conducted and specialist seen. Recurrences were diagnosed in 175 patients of whom 85 were symptomatic and 90 diagnosed on routine imaging. New primaries were diagnosed in 23 patients, 18 with symptoms and 5 on routine imaging. Subsequent treatment was curative in 17 (10%) patients with recurrent disease and 18 (78%) with new primaries. On multivariable analysis, symptomatic diagnosis (P = 0.006) was associated with subsequent curative treatment but not with overall survival (P > 0.05).

Conclusion: The follow-up of patients showed considerable variation between institutions. Routine imaging was not associated with subsequent curative treatment of events or improved overall survival.