Microcitoma (Small Cell Lung Cancer)

8 FOLLOW-UP

8.1 General principles and objectives

8.1.1 General principles and objectives
The actual 5-year survival for limited-stage patients is higher than 5-10% (but can be as high as 60% in highly selected subgroups) and for extensive-stage is as low as 1-2%. About 70% of patients who are disease-free after 2 years do not relapse, and relapses 5 to 10 years after the beginning of initial therapy are exceedingly rare. In 20% of patients a second primary will develop. After 3-4 years of disease-free survival the risk of a second primary exceeds the risk of late relapse. Overall, follow-up examinations have to consider recurrences (chest relapse is approximately 30%), treatment late effects, tobacco-related diseases as well as second primaries.

8.2 Suggested protocols

8.2.1 Suggested protocols
In patients with progressive disease, follow-up examinations are to be performed within a good palliative care program. In patients with no evidence of disease, routine chest X-ray is recommended on a type R basis every 3 months for the first 2 years in order to maximise the probability of an early detection of a chest relapse, which in highly selected cases may be successfully treated with surgery. The role of an annual chest examination in patients at high risk for second lung cancer has recently been reappraised leading to a meaningful benefit of diagnostic anticipation in terms of resectability, stage distribution and survival (8.II). Being these patients at high risk of developing a second lung primary cancer, it seems to be reasonable to recommend a periodical chest X-ray examination for the lifelong period. Every other examination is dictated by patient complaints.

References

8.I
Johnson BE, Grayson J, Makuch RW, et al. Ten-year survival of patients with small cell lung cancer treated with combination chemotherapy with or without irradiation. J Clin Oncol 1990; 8: 396-401.

8.II
Strauss GM, Gleason RE, Sugarbaker DJ. Chest X-ray screening improves outcome in lung cancer. Chest 1995; 107:270S-279S.

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