Key Points
➤ Although patients with localized non-small cell lung cancer (NSCLC) or
small cell lung cancer (SCLC) are treated with intent to cure, the optimal
surveillance of these patients for cancer recurrence and new primary lung
cancers after potentially curative therapy is controversial.
Non-Small Cell Lung Cancer
➤ The chance of NSCLC recurrence is greatest during the first 2 years
following treatment with curative intent.
• Patients with an intrathoracic recurrence may be salvaged with surgical resection,
stereotactic body radiotherapy (SBRT) or chemoradiation depending on the clinical
scenario.
• Early identification of extra-thoracic metastatic recurrence may allow prompt molecular
testing and facilitate the safe administration of precision palliative therapy before patients
develop severe symptoms or deteriorate.
➤ Two or more years after curative intent therapy, patients are at higher risk of
developing a second primary lung cancer (1.5-2% per year) and may benefit
from screening.
Small Cell Lung Cancer
➤ During the first year after initial chemoradiation for SCLC, approximately
40% of patients with stage I-III (limited stage) will relapse. This increases
to 60% during the 3 years post-treatment.
• The risk of intracranial recurrence is significant. Therefore, close central nervous system
(CNS) surveillance may afford treatment before permanent neurologic sequelae develop
from symptomatic SCLC brain metastases.
Recommendations
NOTE:
• These recommendations apply to patients with curatively treated stage I-III NSCLC
and SCLC with no clinical suspicion of recurrent disease. This includes patients treated
with surgery, stereotactic body radiotherapy and chemoradiation. Please refer to the
recommendation discussion section for further details on specific patient subpopulations.
• These recommendations pertain only to routine surveillance strategies. Imaging to
evaluate symptoms and follow-up on previous findings are not addressed by this
guideline.
• These recommendations do not address the frequency of the clinical evaluation (history
and physical exam) for either the suspicion of recurrence and/or to provide reassurance.
