From the Guidelines
The recommended surveillance plan after SBRT for lung cancer typically involves CT imaging every 3-6 months for the first 2 years, then annually thereafter, as suggested by the most recent guidelines 1. This approach is based on the highest quality evidence available, which emphasizes the importance of early detection of recurrence and second primary lung cancers. The initial follow-up visit should occur within 4-6 weeks post-treatment to assess for acute toxicities. During each follow-up, clinicians should perform a thorough history and physical examination focusing on respiratory symptoms, potential treatment-related side effects, and quality of life assessment. Some key points to consider in the surveillance plan include:
- The use of PET-CT may be considered when recurrence is suspected but cannot be confirmed by CT alone, as recommended by 1 and 1.
- Pulmonary function tests should be obtained at baseline and periodically (typically annually) to monitor lung function, especially in patients with pre-existing pulmonary disease.
- The frequency of imaging may be tailored to individual patient needs, with more frequent imaging for those at higher risk of recurrence or second primary lung cancers.
- Smoking cessation should be strongly encouraged, as it leads to superior treatment outcomes, as noted in 1 and 1. This surveillance schedule is designed to detect local recurrence, regional lymph node involvement, distant metastases, and treatment-related complications as early as possible, allowing for timely intervention and potentially improving outcomes. Early detection of recurrence is crucial, as salvage treatment options may still be available, and the risk of second primary lung cancers remains a concern, particularly in patients with a history of smoking. The higher frequency of imaging in the first 2 years reflects the period of greatest recurrence risk, while continued surveillance beyond 5 years may be warranted due to the ongoing risk of second primary lung cancers.
From the Research
Surveillance Plan After SBRT for Lung Cancer
The recommended surveillance plan for patients after Stereotactic Body Radiation Therapy (SBRT) for lung cancer involves regular imaging to detect potential recurrence or second primary lung cancers.
- Patients should undergo a computed tomographic (CT) scan of the chest every 3 months during years 1 and 2, every 6 months during years 3 and 4, and annually thereafter 2.
- Close monitoring with routine CT scans within the first 2 years after SBRT is effective in detecting early disease progression 2.
- The risk for the development of a second primary lung cancer (SPLC) remains elevated beyond 2 years, particularly in former and current smokers 2.
Factors Influencing Surveillance
Several factors can influence the surveillance plan, including:
- The location and size of the tumor 3
- The patient's smoking history 2
- The presence of other health conditions 4
- The patient's overall performance status 5
Imaging Modalities
The choice of imaging modality for surveillance after SBRT for lung cancer includes:
- Computed tomography (CT) scans 2, 6
- Positron emission tomography (PET) scans 6
- The use of these imaging modalities can help detect recurrence or second primary lung cancers, and guide further treatment decisions 6
Treatment Outcomes
The treatment outcomes after SBRT for lung cancer can be influenced by the surveillance plan, with:
- Local control and overall survival rates exceeding 85% at 2 years using predominantly 5-fraction schedules 3
- The risk of toxicity, particularly for ultracentral tumors, which can be minimized with appropriate treatment planning and follow-up 3
- The potential for repeat SBRT for local recurrence of non-small cell lung cancer or lung metastasis after previous local SBRT 5