Posttreatment Surveillance Of Patients Research Articles

SAT-435 Benefits and harms of post-treatment surveillance in patients with early-stage of HCC after curative ablation

SAT-435 Benefits and harms of post-treatment surveillance in patients with early-stage of HCC after curative ablation

Comparing the performance of full-field digital mammography and digital breast tomosynthesis in the post-treatment surveillance of patients with a history of breast cancer: A retrospective study

IntroductionThe purpose of our study was to compare the performance of 2D (FFDM) against 3D (FFDM plus DBT) examinations in the post-treatment surveillance of asymptomatic breast cancer survivors. MethodsA list of women with a history of breast cancer who underwent screening mammography (2D or 3D) from 5/2017 to 5/2020 was retrieved. A total of 20,210 examinations were identified and performance metrics were compared. ResultsThere were no statistically significant difference in cancer detection rate (CDR) (p = 0.38), recall rate (RR) (p = 0.087), or positive predictive value (PPV) (p = 0.74) between 2D vs. 3D examinations. Stratification by breast tissue identified no statistically significant difference in CDR (p = 0.581 and p = 0.428), RR (p = 0.230 and p = 0.205), or PPV (p = 0.908 and p = 0.721) between fatty/scattered and heterogeneous/extremely dense breast tissue when comparing 2D vs 3D examinations. Stratification by age did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 2D vs. 3D examinations in the 60–69 years group (p = 0.021). Stratification by race did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 3D vs. 2D examinations in white women (p = 0.036). Stratification by laterality (bilateral vs. unilateral post mastectomy) did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased in 2D vs. 3D examinations in unilateral studies (p = 0.009). ConclusionFor asymptomatic women with a history of breast cancer, there is no evidence that the addition of DBT to FFDM improves CDR, RR, or PPV. Implications for practiceMore studies are needed concerning screening methodologies supplementing FFDM in the screening regimens of breast cancer survivors.

Detection of Recurrence After Primary Treatment for Oropharyngeal Carcinoma.

Post-treatment surveillance of patients with squamous cell oropharyngeal carcinoma (SCOPC) consists of routine follow-up visits for 5 years. It has been suggested that this program is inefficient for finding recurrences and increasing survival. The primary study objective was to investigate how recurrences after treatment for SCOPC were detected, i.e., at routine follow-up visits, at patient-initiated visits, or incidentally. The secondary objective was to investigate whether 2-year survival after diagnosis of recurrence depended on the manner of detection. Patients with recurrences from SCOPC between 1988 and 2018 were included. Survival was analysed by the Kaplan-Meier method with log-rank test. A total of 75 patients were included. Almost one-third were alive 2 years after the diagnosis of recurrence. Recurrences were detected at routine follow-up visits in 50.7%, at patient-initiated visits in 42.7% and 6.6% were found incidentally. There was an increased survival in the patient-initiated group, but this was not significant. The majority of recurrences in both groups compared were amenable to curative treatment.

Cancer cell detection device for the diagnosis of bladder cancer from urine

Bladder cancer is common and has one of the highest recurrence rates. Cystoscopy, the current gold standard diagnosis approach, has recently benefited from the introduction of blue light assisted photodynamic diagnostic (PDD). While blue light cystoscopy improves diagnostic sensitivity, it remains a costly and invasive approach. Here, we present a microfluidic-based platform for non-invasive diagnosis which combines the principle of PDD with whole cell immunocapture technology to detect bladder cancer cells shed in patient urine ex vivo. Initially, we demonstrate with model cell lines that our non-invasive approach achieves highly specific capture rates of bladder cancer cells based on their Epithelial Cell Adhesion Molecule expression (>90%) and detection by the intensity levels of Hexaminolevulinic Acid-induced Protoporphyrin IX fluorescence. Then, we show in a pilot study that the biosensor platform successfully discriminates histopathologically diagnosed cancer patients (n = 10) from non-cancer controls (n = 25). Our platform can support the development of a novel non-invasive diagnostic device for post treatment surveillance in patients with bladder cancer and cancer detection in patients with suspected bladder cancer.

Practice patterns in post-treatment surveillance in patients with primary epithelial ovarian cancer

BackgroundThe Society of Gynecologic Oncology created guidelines to standardize cost-effective clinical surveillance for detection of recurrence of gynecologic cancers.ObjectiveTo determine practice patterns for surveillance of primary ovarian cancer after complete...

Risk factors for survival and distant metastasis in 125 patients with head and neck adenoid cystic carcinoma undergoing primary surgery.

Adenoid cystic carcinoma (AdCC) is generally slow growing but has highly metastatic potential to distant organs. Several factors and biomarkers are associated with metastasis and treatment outcomes, although further definition is needed. Therefore, this study aimed to evaluate the risk factors for survival and distant metastasis in patients with head and neck AdCC. This study included 125 patients with previously untreated AdCC who underwent primary surgery with or without radiotherapy in our tertiary referral centre. Univariate and multivariate Cox proportional hazard regression analyses were used to identify risk factors associated with overall survival (OS), cause-specific survival (CSS), disease-free survival (DFS), and distant metastasis-free survival (DMFS). Factors associated with OS in patients with distant metastasis were separately analysed. During a median follow-up of 9.8years (range 3.0-22.6years), 58 patients (46.4%) had distant metastasis and 29 (23.2%) died of disease. Multivariate analyses showed that lymphovascular invasion, lymph node metastasis, and distant metastasis were independent factors of OS and CSS outcomes (all P < 0.05). The T classification and extranodal extension were independent factors of DFS and DMFS outcomes (P < 0.05). After patients presented with distant metastasis, the median survival was 5.8years. Multivariate analyses showed that extranodal extension and regional recurrence were independent factors of survival after occurrence of distant metastasis (P < 0.05). Several clinicopathological factors can predict distant metastasis and survival of patients with AdCC treated with primary surgery. This may promote post-treatment surveillance in patients with AdCC.

Prognostic potential of liquid biopsy tracking in the posttreatment surveillance of patients with nonmetastatic nasopharyngeal carcinoma.

The current study was performed to investigate whether circulating cell-free Epstein-Barr virus DNA (cfEBV DNA) would be useful for posttreatment surveillance in patients with nasopharyngeal carcinoma (NPC). The authors identified a total of 1984 nondisseminated NPC patients from an institutional big-data research platform. Blood samples were collected within 3months of the completion of radiotherapy and every 3 to 12months thereafter for cfEBV DNA analysis. Patients were followed until disease recurrence was detected or for a median of 60months. Diagnostic performance was assessed by calculating the sensitivity, specificity, and accuracy based on the clinical detection of disease recurrence by conventional surveillance modalities (imaging scans and pathological examination). During follow-up, a total of 767 patients (38.7%) had detectable cfEBV DNA. The recurrence rate among these patients was 63.8% (489 of 767 patients), which was significantly higher than that in patients with undetectable cfEBV DNA (8.6%; 105 of 1217 patients). cfEBV DNA sensitivity, specificity, and accuracy were 68.8%, 80.0%, and 78.2%, respectively, for local recurrence; 80.2%, 80.0%, and 85.9%, respectively, for regional recurrence; and 91.1%, 80.0%, and 92.8%, respectively, for distant metastasis. cfEBV DNA was found to have higher sensitivity for the detection of extrapulmonary metastases (94.9%-96.5%) compared with pulmonary metastases (78.4%). It is interesting to note that among the patients with disease recurrence with detectable cfEBV DNA, positive cfEBV DNA results preceded radiological and/or clinical evidence of disease recurrence by a median of 2.3months (interquartile range, 0.1-9.5months). In addition, of the 278 cfEBV DNA-positive patients who did not develop disease recurrence, 227 (81.7%) had transiently positive cfEBV DNA that fell to undetectable levels during long-term monitoring. Plasma cfEBV DNA in patients with NPC appears to be an early sign of tumor recurrence, especially extrapulmonary metastases.

Association of NCCN-Recommended Posttreatment Surveillance With Outcomes in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma

National Comprehensive Cancer Network (NCCN) guidelines recommend routine clinical follow-up as posttreatment surveillance for patients with head and neck cancer (HNC). Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV-associated OPSCC) is a unique subset of HNC, associated with fewer recurrences and improved survival. The utility of this guideline in this patient population is unknown. To determine adherence to the NCCN clinical follow-up guideline, frequency of recurrence detection method, classified as symptom-directed, physician-detected, or imaging-detected, and survival benefit associated with adherence to the NCCN guideline. Retrospective cohort study of patients with HPV-associated OPSCC diagnosed between January 1, 2011, and April 30, 2014, at a large integrated health care system. Multivariable analyses were conducted using the Cox proportional hazards regression model, with patient adherence to NCCN visit guidelines constructed as a time-dependent variable. All data analyses were complete on September 1, 2018. Posttreatment clinical and imaging surveillance. Recurrence and overall survival. Secondary outcome was salvage therapy. Of the 233 study patients with HPV-associated OPSCC, the mean (SD) age at diagnosis was 60.5 (8.7) years; 201 (86.3%) were male, 189 (81.1%) were white, and 109 (46.8%) had a positive smoking history. Median follow-up time through recurrence or all-cause mortality was 4.5 years (interquartile range, 3.8-5.6). Patients demonstrated 83.0% (180 of 217) adherence to NCCN surveillance guidelines in year 1, 52.7% (106 of 201) in year 2, 73.4% (141 of 192) in year 3, 62.3% (96 of 154) in year 4, and 52.9% (45 of 85) in year 5. A total of 3358 clinical surveillance examinations were performed with 22 patients having recurrences. There were 10 symptom-directed, 1 physician-detected, and 11 imaging-detected recurrences. Of the symptom-directed recurrences, salvage therapy was attempted in 5; at the study end date, 1 was alive. Salvage neck dissection was attempted in the physician-detected recurrence; this patient subsequently died. All locoregional recurrences occurred within the first 2 years, and all salvageable recurrences within the first year. Adherence to NCCN guidelines was not protective against all-cause mortality in the multivariable Cox proportional hazards regression model (hazard ratio, 0.76; 95% CI, 0.28-2.05). Among patients with HPV-associated OPSCC, clinical surveillance is of limited utility. Nearly all clinically detected recurrences were elicited by patient symptoms that prompted earlier presentation to the clinician. Adherence to the current schedule does not appear to confer survival advantage, and locoregional recurrences are almost never detected beyond 2 years. These findings support reduction of posttreatment clinical surveillance in this population.

Liquid Biopsy of HPV DNA in Cervical Cancer

(Abstracted from J Clin Virol 2019;114:32–36) Despite the introduction of the human papillomavirus (HPV) vaccine, 2 HPV subtypes, HPV16 and HPV18, are responsible for greater than 70% of cervical cancers. Posttreatment surveillance for patients with cervical cancer currently involves physical examination and imaging studies.

The impact of different brain imaging strategies for initial staging and post-treatment surveillance in patients with EGFR-mutant lung adenocarcinomas.

e21145Background: According to NCCN guideline, brain MRI is suggested for lung cancer staging; however, brain CT is still commonly used in clinical practice. In addition, the brain surveillance str...

Abstract 1735: Assessing circulating tumor cells with a nanotechnology-based capture system as a novel biomarker for treatment response and surveillance in patients with oligometastatic solid tumors

Abstract Purpose: To prospectively evaluate changes in circulating tumor cells (CTCs) following definitive treatment in patients with oligometastatic solid tumors using a novel nanotechnology-based biomimetric platform. Experiment Procedures: Patients with biopsy proven oligometastatic disease with up to three lesions were eligible if all sites of disease were treated with definitive therapy. Definitive therapy could include fractionated 3D conformal radiation, SBRT, IORT, surgical metastatectomy, and ablative procedures including microwave ablation. Patients initially presenting with oligometastatic disease were eligible if they had less than 3 lesions including the primary tumor. At least one lesion had to be treated with radiation. CTCs were enumerated from whole blood using the Onco-Sense CTC capture system which utilizes E-selectin and dendrimers functionalized with three cancer-specific antibodies (aEpCAM, aHER-2, aEGFR). Whole blood was collected from patients prior to starting treatment (baseline), mid-treatment, end of treatment, within 12 weeks of finishing treatment, and then every 3 months in follow up. We then assessed changes in CTCs with treatment and looked for associations between baseline CTCs, changes during treatment, and post-treatment changes with clinical outcomes. Results: We have currently enrolled 24 patients. The majority of patients (20) had a single site of disease treated with radiosurgery. Sites of metastasis include bone, lung, and lymph nodes. Primary histologies include lung, breast, melanoma, prostate, RCC, colorectal cancer, and SCC of the head and neck. CTCs were detected in 100% of patients at baseline and decreased with treatment from a mean of 45 CTCs/mL pretreatment (range 3-99) to 14 CTCs/mL post-treatment (range 3-59). Post-treatment CTCs are available for 14 patients with a median follow up of 10.3 months. Ten of 14 patients remain clinically NED and post-treatment CTCs are lower than baseline in 13/14 of these patients. There have been 4 clinical failures and CTCs increased with or before radiographic progression in all 4 patients. Three of the failures occurred at least 3 months after initial complete responses to treatment and CTCs increased by a median 3.4-fold over post-treatment levels in these patients. One patient progressed before the first post-treatment follow up and CTCs increased from 7 to 22 CTCs/mL from baseline to post-treatment. Conclusions: We showed here that we could enumerate CTCs in 100% of patients with oligometastatic disease using a novel CTC capture system. CTCs decreased with treatment and all clinical failures were preceded by significant rises in CTCs. Our preliminary data suggest that enumeration of CTCs by Onco-Sense may provide a novel biomarker for assessing treatment response and/or post-treatment surveillance for patients with oligometastatic solid tumors. Note: This abstract was not presented at the meeting. Citation Format: Joseph M. Caster, Kyle Wang, Bhisham Chera, Sin-Jun Park, Seungpyo Hong, Andrew Z. Wang. Assessing circulating tumor cells with a nanotechnology-based capture system as a novel biomarker for treatment response and surveillance in patients with oligometastatic solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1735. doi:10.1158/1538-7445.AM2017-1735

Droplet digital PCR for detection and quantification of circulating tumor DNA in plasma of head and neck cancer patients

BackgroundDuring posttreatment surveillance of head and neck cancer patients, imaging is insufficiently accurate for the early detection of relapsing disease. Free circulating tumor DNA (ctDNA) may serve as a novel biomarker for monitoring tumor burden during posttreatment surveillance of these patients. In this exploratory study, we investigated whether low level ctDNA in plasma of head and neck cancer patients can be detected using Droplet Digital PCR (ddPCR).MethodsTP53 mutations were determined in surgically resected primary tumor samples from six patients with high stage (II-IV), moderate to poorly differentiated head and neck squamous cell carcinoma (HNSCC). Subsequently, mutation specific ddPCR assays were designed. Pretreatment plasma samples from these patients were examined on the presence of ctDNA by ddPCR using the mutation-specific assays. The ddPCR results were evaluated alongside clinicopathological data.ResultsIn all cases, plasma samples were found positive for targeted TP53 mutations in varying degrees (absolute quantification of 2.2–422 mutational copies/ml plasma). Mutations were detected in wild-type TP53 background templates of 7667–156,667 copies/ml plasma, yielding fractional abundances of down to 0.01%.ConclusionsOur results show that detection of tumor specific TP53 mutations in low level ctDNA from HNSCC patients using ddPCR is technically feasible and provide ground for future research on ctDNA quantification for the use of diagnostic biomarkers in the posttreatment surveillance of HNSCC patients.

The role of changes in maximum standardized uptake value of FDG PET-CT for post-treatment surveillance in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy: preliminary findings.

No clear consensus exists regarding the optimal interval and frequency of follow-up positron emission tomography (PET)-CT in patients with head and neck squamous cell carcinoma (HNSCC) treated with chemoradiotherapy (CRT). Here, we sought to clarify whether the changes in the maximum standardized uptake value (ΔSUVmax) may be a valid parameter to help decision-making for surveillance management after CRT. 40 patients underwent PET-CT at pre-treatment and 3 months after CRT. Patients were followed by sequential PET-CT for 2 years after CRT. The ΔSUVmax of the primary tumour and the metastatic nodes were calculated between pre-treatment and 3 months after the CRT, and we evaluated the associations between ΔSUVmax and the manifestation of recurrence, time to recurrence and the patient survival. The ΔSUVmax of the primary tumour was significantly lower for the lesions with recurrence than that for those with non-recurrence for both the primary site and the nodal site (p = 0.007, 0.02). A significant correlation was found between the time to recurrence and the ΔSUVmax of the primary tumour (r = 0.63, p < 0.05). The threshold ΔSUVmax of the primary tumour of 1.04 revealed 76.9% sensitivity and 86.4% specificity for distinguishing recurrence from non-recurrence. The progression-free survival and overall survival of the two patient groups divided by the ΔSUVmax of the primary tumour at 1.04 showed a significant difference (p = 0.003, 0.02). The ΔSUVmax of the metastatic nodes did not show a significant association with recurrence or patient survival. The ΔSUVmax of the primary tumour showed a significant association with recurrence and patient survival. Advances in knowledge: The ΔSUVmax of the primary tumour may be a valid clinical parameter to help decision-making for the surveillance management of patients with HNSCC after CRT.

Posttreatment Surveillance in Patients with Prolonged Disease-Free Survival After Resection of Colorectal Liver Metastasis.

IntroductionPosttreatment surveillance protocols most often endure for 5 years after resection of colorectal liver metastasis (CRLM). Most recurrences happen within 3 years after surgical removal of the tumour. This study analysed the need of surveillance for patients with at least 3 years of disease-free survival after potentially curative resection of CRLM.MethodsA single-centre, retrospective analysis of all consecutive patients who underwent treatment for CRLM with curative intent between 2000 and 2011.ResultsIn total, 152 of 545 patients (28 %) remained disease-free for 3 years after successful resection of the CRLM. The estimated recurrence rate after 10 years of follow-up in this group of 152 patients was 27 %. More than half of these patients (55 %) could be treated with curative intent for their recurrences. Multivariable analysis revealed that the nodal status of the primary tumour is of significant prognostic value for developing recurrences after 3 years of disease-free survival. A disease-free interval of less than 12 months between resection of primary tumour and detection of CRLM shows a trend towards significance. Both factors were used to create a risk score, showing that patients with a low-risk profile (node-negative status and a disease-free interval <12 months) have an estimated recurrence rate of 5 % and might not benefit from intensive surveillance beyond 3 years of follow-up without a recurrence.ConclusionsThe currently developed risk score shows that follow-up can be stopped in a specific subgroup 3 years after treatment for their CRLM with curative intent.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5388-8) contains supplementary material, which is available to authorized users.

Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era

The role of surveillance studies in limited-stage diffuse large B-cell lymphoma (DLBCL) in the rituximab era has not been well defined. We sought to evaluate the use of imaging (computed tomography [CT] and positron emission tomography [PET]-CT) scans and lactate dehydrogenase (LDH) in surveillance of patients with stage I to II DLBCL. A retrospective analysis was performed of patients who received definitive treatment between 2000 and 2013. One hundred sixty-two consecutive patients with stage I to II DLBCL were treated with chemotherapy +/- rituximab, radiation, or combined modality therapy. The 5-year rates of overall survival (OS) and freedom from progression (FFP) were 81.2% and 80.8%, respectively. Of the 162 patients, 124 (77%) were followed up with at least 1 surveillance PET scan beyond end-of-treatment scans; of those, 94 of 124 (76%) achieved a complete metabolic response on PET scan after completion of chemotherapy, and this was associated with superior FFP (P=.01, HR=0.3) and OS (P=.01, HR 0.3). Eighteen patients experienced relapse after initial response to therapy. Nine relapses were initially suspected by surveillance imaging studies (8 PET, 1 CT), and 9 were suspected clinically (5 by patient-reported symptoms and 4 by symptoms and physical examination). No relapses were detected by surveillance LDH. The median duration from initiation of treatment to relapse was 14.3 months among patients with relapses suspected by imaging, and 59.8 months among patients with relapses suspected clinically (P=.077). There was no significant difference in OS from date of first therapy or OS after relapse between patients whose relapse was suspected by imaging versus clinically. Thirteen of 18 patients underwent successful salvage therapy after relapse. A complete response on PET scan immediately after initial chemotherapy is associated with superior FFP and OS in stage I to II DLBCL. The use of PET scans as posttreatment surveillance is not associated with a survival advantage. LDH is not a sensitive marker for relapse. Our results argue for limiting the use of posttreatment surveillance in patients with limited-stage DLBCL.

Imaging surveillance of patients with breast cancer after primary treatment: current recommendations.

Women who have been treated for breast cancer are at risk for second breast cancers, such as ipsilateral recurrence or contralateral metachronous breast cancer. As the number of breast cancer survivors increases, interest in patient management and surveillance after treatment has also increased. However, post-treatment surveillance programs for patients with breast cancer have not been firmly established. In this review, we focus on the imaging modalities that have been used in post-treatment surveillance for patients with breast cancer, such as mammography, ultrasonography, magnetic resonance imaging, and positron emission tomography, the effectiveness of each modality for detecting recurrence, and how they can be applied to manage patients.

Post-treatment surveillance of patients with colorectal cancer with surgically treated liver metastases

Little is known about current surveillance patterns after treatment of colorectal liver metastasis (CRLM) or whether the intensity of surveillance correlates with outcome. We sought to define current population-based patterns of surveillance and investigate whether intensity of surveillance impacted outcome. We queried the Surveillance, Epidemiology, and End Results-linked Medicare database for patients with CRLM diagnosed between 1991 and 2005 who underwent liver resection and/or tumor ablation. Frequency of post-treatment abdominal computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) was recorded for ≤ 5 years after treatment. The association between frequency of imaging with secondary interventions and long-term survival were analyzed. We identified 1,739 patients with CRLM treated with surgery; median age was 73 years, and the majority were male (52.6%). CRLM treatment consisted of liver resection (61%), ablation (32%), or both simultaneously (6%). CT (97%) was utilized more often for post-treatment surveillance compared with MRI (7%) and PET (18%). A temporal trend was noted with more frequent surveillance imaging obtained in post-treatment year 1 (2.4 scans/year) versus year 5 (0.6 scans/year; P = .01); 66% of living patients had no imaging after 2 years. Frequency of surveillance imaging correlated with procedure type (total number of scans/5 years: resection, 5.0; ablation, 4.6; resection and ablation, 6.2; P = .01). Other factors associated with a greater frequency of surveillance included younger age at diagnosis, geographic location in the South, and CRLM directed surgery in 2000 through 2005 (all P < .05). Overall survival did not differ by intensity of surveillance imaging (3-4 scans/yr, 43 months vs 2 scans/yr, 57 months vs 1 scan/yr, 54 months; P = .08). Marked heterogeneity exists in how often surveillance imaging is obtained after treatment of CRLM. Intensity of imaging does not affect time to second procedure or median survival duration. Surveillance guidelines for CRLM need to be refocused to provide the best value for healthcare resources.

Sinonasal undifferentiated carcinoma and esthesioneuroblastoma recurring as nonintestinal adenocarcinoma

Numerous distinct neoplasms are encountered at the anterior cranial base. Management of these primary tumors and their locoregional recurrences are dictated by the histopathologic diagnosis. We present two unusual cases of extra-axial anterior cranial base malignancies with locoregional recurrence where the recurrent tumor encountered was of a distinct histopathologic type. While rare, this report highlights the possibility of encountering a distinct tumor type in the posttreatment surveillance of patients with anterior cranial base malignancies.

Post-Treatment Surveillance of Patients With Colorectal Liver Metastases: Does Intensity of Follow-up Imaging Impact Outcomes

Post-Treatment Surveillance of Patients With Colorectal Liver Metastases: Does Intensity of Follow-up Imaging Impact Outcomes

Surveillance of Pancreatic Cancer Patients after Surgical Resection

There are no clear recommendations to guide posttreatment surveillance in patients with pancreatic cancer. Our goal was to describe the posttreatment surveillance patterns in patients undergoing curative-intent resection for pancreatic cancer. We used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data (1992-2005) to identify CT scans and physician visits in patients with pancreatic cancer who underwent curative resection (n = 2393). Surveillance began 90 days after surgery, and patients were followed for 2 years at 6-month intervals. Patients were censored if they died, experienced recurrence of disease, or entered hospice. A total of 2045 patients survived uncensored to the beginning of the surveillance period. CT scan use decreased from 20.9% of patients in month 4 to 6.4% in month 27. There was no temporal pattern in CT use to suggest regular surveillance. Twenty-three percent of patients did not receive a CT scan in the year after surgery, increasing to 42% the second year. Patients who underwent adjuvant therapy and patients diagnosed in later years had higher CT scan use over the surveillance periods. Most patients visited both a primary care physician and a cancer specialist in each 6-month surveillance period. Patients who visited cancer specialists were more likely to have any CT scan and to be scanned more frequently. Current surveillance patterns after resection for pancreatic cancer reflect the lack of established guidelines, implying a need for evaluation and standardization of surveillance protocols. The lack of a temporal pattern in CT testing suggests that most were obtained to evaluate symptoms rather than for routine surveillance.