Effect of follow-up surveillance after curative-intent treatment of NSCLC on detection of new and recurrent disease, re-treatment and survival: A systematic review and meta analysis.

Abstract

INTRODUCTION\nPatients with NSCLC may be treated with curative intent, yet remain at high risk of both disease recurrence, second primary lung cancer and increased risk of early death. Guidelines provide recommendations for follow up but there is little consensus and review of available evidence is necessary.\n\n\nHYPOTHESIS\nThe use of a systematic follow up strategy for the detection of disease recurrence or second primary lung cancer (SPLC) after curative intent treatment of NSCLC may increase the proportion of patients available for retreatment and increase survival for surveillance detected patients.\n\n\nMETHODS\nWe performed a systematic review and meta analysis of prospective studies on follow up of NSCLC after curative intent treatment to answer three questions. What is the effect of follow up on detection of recurrence or SPLC? What is the effect of surveillance detection on curative intent retreatment? What is the survival impact?\n\n\nRESULTS\nRecurrence/SPLC was observed in 17.8-71% of patients. Scheduled imaging detected recurrence in 60-100% of cases, yet neither CT-based (OR 2.31; 95% CI 0.27-19.49, p=0.44) nor PET-CT-based follow up (OR 1.431; 95% CI 0.92-2.22, p=0.12) were statistically superior to standard follow up strategies. Detection of disease recurrence/SPLC significantly increased the odds of curative intent retreatment (OR 4.31; 95% CI 2.10-8.84, p<0.0001). Curative intent retreatment prolonged survival in reported studies.\n\n\nCONCLUSIONS\nThe early detection of disease recurrence/SPLC may increase likelihood of curative intent retreatment and prolong survival. There is clear need for prospective randomised controlled studies of follow up to confirm effectiveness of available follow up modalities.