Surveillance Imaging Following Curative-Intent Surgery for Non-Small Cell Lung Carcinoma: A Systematic Review

Following curative surgery for non-small cell lung carcinoma (NSCLC), patients remain at risk for recurrence of lung cancer or for development of second primary lung cancer (SPLC). While periodic surveillance may detect early stage recurrence or SPLC, the effectiveness of surveillance has not been established. Additionally, current practice guidelines conflict in terms of the optimal frequency of surveillance and modalities to employ. The purpose of this study is to evaluate whether the use of surveillance following curative surgery for NSCLC is effective in diagnosing recurrence or SPLC in asymptomatic patients, in comparison to usual care. Electronic databases (MEDLINE, EMBASE, CINAHL, and Cochrane Library) were searched for pertinent studies published between 1990 and 2010. Major search concepts included non-small cell lung carcinoma, surveillance, curative resection, recurrence, second primary lung cancer, computed tomography, and chest x-ray. Baseline data and results from individual studies were pooled. Odds ratios and confidence intervals were computed for each of the following endpoints: detection of recurrence by surveillance, asymptomatic presentation at recurrence, and site of recurrence. Eighteen cohort and case-control studies were included in this analysis. No randomized controlled trials were identified. A total of 1019 recurrences and second primary lung cancers were detected among 2716 patients. 53.1% of cases were detected by surveillance protocol (OR 1.28, 95% CI 0.97-1.69). 34.9% of patients were asymptomatic at time of detection (OR 0.42, 95% CI 0.33-0.53). Distant recurrence occurred much more frequently than local recurrence (OR 2.69, 95% CI 2.17-3.35). Only 172 patients were offered a second curative-intent surgery (16.9%). Current literature does not argue for or against routine surveillance imaging after curative surgery for NSCLC. We await the results of randomized, controlled trials to provide more conclusive evidence.