Interna(onal Guidelines vary in their recommenda(ons for followup (FU) a=er treatment for NonSmall Cell Lung Cancer (NSCLC) Australian 5 , ACCP 6 , ESMO 7 and NCCN 8 : 6m for 2/3 y and yearly therea=er. ASCO 2 , Canada 3 , and Chinese 4 guidelines: 3m for 2y, 6m 25y, and yearly >5y. FU is important to manage treatment toxici(es, diagnose events (recurrence or new primaries) and provide suppor(ve management CONCLUSION • FOLLOWUP PRACTICE WAS VARIABLE ACROSS THE THREE INSTITUTIONS. • THE MAJORITY OF EVENTS OCCURRED WITHIN 3 YEARS POSTRADIOTHERAPY • THERE WAS A STEADY INCREASED RISK OF NEW PRIMARY CANCERS UP TO 9 YEARS AFTER TREATMENT • ROUTINE IMAGING WAS NOT ASSOCIATED WITH IMPROVED SURVIVAL • STANDARDISED ROUTINE FOLLOWUP PROTOCOL MAY PREVENT SYMPTOMATIC HOSPITAL PRESENTATIONS • Median no. of FU visits = 6 (046) & Median period of FU = 10.8 months (0104.2) • 73.7% were rou(ne, 26.3% were symptoma(c visits • 1641 imaging tests were performed = an average of 5.8 scans/pa(ent • 98 imaging studies resulted in the asymptoma(c diagnosis of an event METHODS AND MATERIALS Retrospec(ve data collec(on of Oncology and Hospital records at 3 Cancer Therapy Centers: St George Illawarra Liverpool/Macarthur Inclusion criteria Stage IIII NSCLC pa(ents Completed cura(ve dose of radiotherapy (min: 50Gy) +/ chemotherapy between 20072011 Not treated with surgery Sample size = 283 pa(ents Data collec(on: Demographics: Age, Gender, ECOG, Alive/Dead status, Date of death, Cause of death Cancer Factors: Date of diagnosis, Stage, Histopathology, Treatment Followup: Date, Specialist, Symptoms, Imaging Recurrence/New Primary: Date of diagnosis, Method of diagnosis, Treatment, Intent PURPOSE 1. To compare paberns of postradiotherapy FU care at 3 metropolitan Sydney Hospitals 2. To evaluate the role of rou(ne imaging in FU 3. To es(mate the propor(on of pa(ents suitable for cura(ve interven(ons a=er diagnosis of recurrence or new primary lung cancer during FU Figure 1 ProporFons of rouFne and symptomaFc FU by hospital 1 AIHW. Cancer in Australia 2017 Canberra: Australian Government. 2017. 2 Pfister DG, et al. J Clin Oncol. 2004;22(2):33053. 3 Ung YC, et al. Followup and surveillance of cura(vely treated lung cancer pa(ents. Ontario: Cancer Care Ontario. 2014. 4 Zhi XY, Yu JM, Shi YK. Chinese guidelines on the diagnosis and treatment of primary lung cancer. Cancer. 2015;121(17):316581. 5 Party TW. Clinical Prac(ce Guidelines for the Preven(on, Diagnosis and Management of Lung Cancer. NHMRC. 2004. 6 Colt HG, et al. Followup and surveillance of the pa(ent with lung cancer a=er cura(veintent therapy: Diagnosis and management of lung cancer, 3rd ed: ACCP. Chest. 2013;143(5):43754. 7 Vansteenkiste J, et al. 2nd ESMO Consensus Conference on Lung Cancer: earlystage nonsmallcell lung cancer consensus on diagnosis, treatment and followup. Ann Oncol. 2014;25(8):146274. 8 Shead DA, et al. NCCN guidelines for pa(ents. NCCN. 2016:5984. Followup of Stage IIII NSCLC: Who, When and How? S. MOHAN 1 , J. SHAFIQ 2 , N. BEYDOUN 3 , E. NASSER 4 , A. NGUYEN 1 and S. VINOD 5 1 University of New South Wales, Sydney, NSW, Australia, 2 Ingham Ins(tute, Liverpool, NSW, Australia, 3 St George Hospital Cancer Care Centre, Kogarah, NSW, Australia, 4 Illawarra Cancer Care Centre, Wollongong, NSW, Australia, 5 Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia RESULTS N % Gender Male 183 64.7 Female 100 36.3 Age at diagnosis <60 years 36 12.7 6069 years 83 29.3 7079 years 89 31.4 80+ years 75 26.5 Histopathology Large Cell Carcinoma 90 31.8 Squamous Cell Carcinoma 100 35.3 Adenocarcinoma 69 24.4 NSCLC NOS 25 8.8 ECOG 0 80 28.3 1 152 53.7 2 39 13.8 3 6 2.1 Unknown 6 2.1 Stage Stage I 79 29.7 Stage II 47 16.6 Stage III 105 53.7 IniSal Treatment Radiotherapy 160 56.5 Sequen(al Chemoradiotherapy 18 6.4 Concurrent Chemoradiotherapy 105 37.1 Table 1 – CharacterisFcs of study paFents 59% 13% 8% 4% 1% 6% 9% Liverpool 49% 7% 18% 2% 4% 20% Illawarra 46% 22% 14% 2% 2% 7% 7% St George Routine RO Routine MO Routine Specialist Symptomatic RO Symptomatic MO Symptomatic Specialist Symptomatic Hospital 17% 42% 11% 9% 6% 1% 3% 2% 9% Liverpool 39% 28% 6% 4% 5% 2% 5% 2% 9% Illawarra 9% 54% 11% 8% 4% 2% 3% 3% 6% St George CXR CT Chest CT Abdomen CT Pelvis CT Brain MRI Brain Bone Scan PET Other Figure 2 – Types of imaging done at FU by hospital Figure 5 – Flowchart of events, method of diagnosis and subsequent treatment intent BACKGROUND Author Contact: Sharanya Mohan Email: [email protected] REFERENCES Figure 3 – No. of events (recurrence/new primary) by Fme for Stage I+II paFents 0 10 20 30 40 50 60 70 80 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 Time posttreatment (years) Stage I+II Recurrence Stage I+II New Primary Figure 4 – No. of events (recurrence/new primary) by Fme for Stage III paFents 0 20 40 60 80 100 120 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 Time posttreatment (years) Stage III Recurrence Stage III New Primary 90% of Stage I&II recurrences occurred by 4.37 years 90% of Stage III recurrences occurred by 2.20 years • Symptoma(c diagnosis of an event was associated with delivery of subsequent cura(ve treatment (p=0.049) but was not significantly associated with overall survival (p=0.862) • No other pa(ent, tumor or ini(al treatment factors were significantly associated with subsequent cura(ve treatment (p>0.05) Event Recurrence (175) Symptomatic diagnosis (85) Palliative (70) Curative (15) Imaging diagnosis (90) Palliative (80) Curative (10) New Primary (23) Symptomatic diagnosis (16) Palliative (3) Curative (13) Imaging diagnosis (5) Palliative (0) Curative (5) 18% 11% 81% 100%