Systematic Postoperative Radiologic Follow-up in Patients With Non–Small Cell Lung Cancer for Detecting Second Primary Lung Cancer in Stage IA—Invited Critique

Abstract

Hypothesis: Systematic postoperative evaluation of patients with non-small cell lung cancer will identify treatable second primary lung cancer and local recurrences. Design: Retrospective review from January 1, 1996, to December 31, 2000. The follow-up protocol included an annual computed tomographic examination of the chest with interval chest radiography every 4 months for 2 years and every 6 months for 3 additional years. Setting: A National Cancer Institute-designated comprehensive cancer center. Patients: One hundred twenty-four patients with resected non-small cell lung cancer. Main Outcome Measures: Number and size of second primary and locally recurrent tumors, secondary surgical procedures, and survival of patients who underwent resection. Results: The median diameter of resected second primary tumors detected by computed tomography was 14 mm (range, 8-28 mm) and by chest radiography was 26.5 mm (range, 23.0-35.0 mm) (P<001). Of 14 patients with second primary lung cancer treated surgically, 9 were without evidence of disease at a median of 20 months (range, 4-56 months), 2 were alive with disease at 13 and 37 months, 2 died of unrelated causes but without evidence of disease at 7 and 35 months, and 1 died intraoperatively of a cardiac arrhythmia. Conclusions: Systematic follow-up of non-smail cell lung cancer, including annual computed tomography, detects second primary lung cancer in stage IA. Limited pulmonary resections are often feasible in these patients. Locally recurrent lung cancer is infrequently resectable.