Timing of Imaging After Concurrent Chemoradiotherapy for Stage III Unresectable NSCLC Adenocarcinoma
Surveillance imaging should be performed every 6 months for the first 2 years with contrast-enhanced chest CT at 12 and 24 months minimum, followed by annual imaging thereafter. 1
Initial Post-Treatment Surveillance Schedule
For the first 2 years after completing concurrent chemoradiotherapy:
- Perform surveillance visits every 6 months that include history, physical examination, and preferably contrast-enhanced volume chest CT scan 1
- At minimum, obtain contrast-enhanced chest CT at 12 months and 24 months post-treatment 1
- These visits should monitor for treatment-related complications, detection of treatable relapse, and occurrence of second primary lung cancer 1
Long-Term Follow-Up After 2 Years
After the initial 2-year surveillance period:
- Transition to annual visits including history, physical examination, and chest CT scan 1
- Continue annual imaging indefinitely to detect second primary tumors or late relapse 1
Critical Timing Considerations for Durvalumab Consolidation
If the patient is eligible for consolidation durvalumab:
- Imaging must be performed to confirm no disease progression before initiating durvalumab 1
- Durvalumab should be started 1 to 42 days after completing chemoradiotherapy 1
- This narrow window necessitates prompt post-treatment imaging assessment, typically within 4-6 weeks of completing radiation 1
Imaging Modality Specifications
The preferred imaging approach includes:
- Contrast-enhanced volume chest CT scan is the primary modality for surveillance 1
- Consider PET-CT if there is clinical suspicion of recurrence or equivocal findings on standard CT 1
- Brain imaging (contrast-enhanced MRI preferred, or CT if MRI unavailable) should be performed if neurological symptoms develop 1
Common Pitfalls to Avoid
Do not delay initial post-treatment imaging beyond 6-8 weeks, as this may miss the window for durvalumab consolidation therapy, which has demonstrated significant survival benefit (median OS 47.5 months vs 29.1 months) 1
Do not rely solely on clinical assessment without imaging, as asymptomatic progression or second primary tumors may be missed, and early detection of treatable relapse is a primary goal of surveillance 1
Do not perform imaging more frequently than recommended without clinical indication, as this increases cost and radiation exposure without proven benefit in asymptomatic patients 1