Rachel Musson MBChB, MRCP, Presenter: Nothing to Disclose

Patricia Fisher, Abstract Co-Author: Nothing to Disclose

Sue Matthews, Abstract Co-Author: Nothing to Disclose

Debate surrounds imaging follow up after radical lung cancer treatment. In our practice, a 3 month post treatment contrast enhanced CT scan is performed; primarily as a baseline but also to assess treatment response/recurrent disease. Our aim is to ascertain the impact of this scan on further management.  

The case notes and baseline CT scans of 129 consecutive patients receiving radical lung cancer treatment between January 2006 and December 2007 were reviewed retrospectively. The post treatment clinical course, requirement for symptomatic scanning and radiological features of the baseline CT scans, especially those that might mimic disease recurrence, were noted.

A baseline post treatment CT scan was performed in 79 (61%) patients (43/51 post radiotherapy, mean time to scan 4.3 months, range 3-6 months; 36/78 post surgery, mean time to scan 5.5 months, range 3-11 months). In the post radical radiotherapy group 12/43 (28%) scans were considered useful: 3 showed unsuspected metastases, 3 progressive disease, one incidental pulmonary embolism and 5 provided a valuable baseline enabling the differentiation of fibrosis from recurrence on investigation of new symptoms. A further 9/43 (21%) had extensive radiotherapy change or residual mass and the baseline may be useful yet, dependant on the patient’s subsequent clinical course. In 22/43 (51%) the scan did not affect management.  In the post surgery group (2 pneumonectomies, 34 lobectomies): 1/36 (3%) scan revealed disease progression, 3/36 (8%) scans showed extensive residual abnormality and may be useful for comparison in the future and 32/36 (89%) did not provide information affecting management. 22/36 (61%) showed expected post-operative changes that were unlikely to be interpreted as recurrent disease at a later stage.  

The baseline scan proved useful in 28% of post radiotherapy patients imaged and permitted an informed choice on further treatment. In comparison, the baseline scan affected management in only 3% of post surgery patients. Therefore a 3 month baseline contrast enhanced CT scan is considered beneficial for patients after radical radiotherapy and is probably not useful following surgery.

A 3 month baseline CT scan is useful in a significant proportion of radical radiotherapy patients and is recommended in this group only. It is rarely useful post surgery and, therefore, not advised.

Musson, R, Fisher, P, Matthews, S, Computed Tomography Follow-up Following Radical Non-Small Cell Lung Cancer Treatment: Comparison of the Utility of a Baseline Scan in Radical Radiotherapy and Surgery Groups.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8004208.html