Lung%20cancer Management

 Follow-Up After Therapy for Patients with Non-Small Cell Lung Cancer (NSCLC)

• Studies have shown 6.5% annual recurrence rate of NSCLC stage I and SCLC, respectively
• Observation for complications of treatment is recommended for at least 3-6 months

• Follow up with history, physical exam and chest computed tomography (CT) scan with or without contrast is advised every 6 months for 2-3 years; then history, physical exam and low-dose chest CT scan without contrast annually thereafter for patients with stage I-II NSCLC given primary treatment including surgery with or without chemotherapy
  
  • High-resolution CT scan is recommended 4 years after surgical resection of stages IA to IIIA NSCLC, followed by low dose computed tomography (LDCT) every year starting in the 5th year
  • Peak incidence of recurrence is between 2 and 3 years

• For patients with stage I-II NSCLC given primary treatment with radiotherapy, and patients diagnosed with stage III or IV NSCLC, history, PE, and chest CT scan with or without contrast is advised every 3-6 months for 3 years; then history, PE and chest CT scan with or without contrast every 6 months for 2 years, then history and PE with low-dose chest CT scan without contrast annually
• For patients with advanced or metastatic disease, response to initial therapy should be assessed after 2 cycles using CT with or without contrast on previously identified tumor sites, then every 2-4 cycles or when clinically indicated
  • Assessment of response to subsequent therapy should be done every 6-12 weeks using CT with or without contrast on previously identified tumor sites
• It is recommended that all screening and follow-up CT scans should be performed at a dose of 100-120 kVp and 40-60 mAs or less 
• Biomarkers (eg ALK fusion oncogene, ROS1 gene rearrangements, BRAF V600E mutations, EGFR mutations, PD-1 ligand) may be utilized to predict treatment outcome or disease prognosis
• Patients who smoke should be advised to quit
  
  • Please see Smoking Cessation disease management chart for further information

• Immunizations (pneumococcal vaccine, influenza vaccine, Herpes zoster vaccine) may also be given

Follow-Up After Therapy for Patients with Small Cell Lung Cancer (SCLC)

• Patients with limited disease (LD) are advised to follow up every 3 months for the 1st year or two, then every 6 months during the 3rd year, then annually after recovery
• Patients with extensive disease (ED) are advised to follow up every 2 months during the 1st year, then every 3-4 months on years 2-3, then every 6 months on years 4-5, then annually
• It is recommended that all screening and follow-up CT scans should be performed at a dose of 100-120 kVp and 40-60 mAs or less  
• Response assessment using chest, pelvic and abdominal CT scan with contrast, or brain MRI or CT with contrast depends on previous treatment given and stage of patient's disease:
  • LD SCLC patients given adjuvant chemotherapy or chemoradiotherapy: Only after completion of treatments
  • LD SCLC patients given systemic therapy or chemoradiotherapy: After every 2 cycles of systemic therapy and at completion of treatments
  • ED SCLC patients given systemic therapy: After every 2-3 cycles of systemic therapy and at completion of therapy
• Response assessment of ED SCLC patients with asymptomatic brain metastasis receiving systemic therapy prior to WBRT should undergo brain magnetic resonance imaging (MRI) or CT scan with contrast every 2 cycles of chemotherapy and after completion of therapy