UTILITY OF SCREENING PROCEDURES FOR DETECTING RECURRENCE OF DISEASE AFTER COMPLETE RESPONSE IN PATIENTS WITH SMALL-CELL LUNG-CARCINOMA

BACKGROUND. Studies evaluating the efficacy of routine follow-up testi ng in detecting disease recurrence in treated lung carcinoma patients are lacking. METHODS. To investigate this subject, the authors studied 115 patients who had previously been entered on North Central Cancer Treatment Group (NCCTG) small cell lung carcinoma clinical trials, had achieved a complete response after chemotherapy/radiotherapy treatmen t, and subsequently developed disease progression. The authors include d 58 patients with limited stage and 57 patients with extensive stage disease. Follow-up testing on these clinical trials was scheduled at 4 -month intervals in the first year and every 6 months thereafter. At e ach visit, testing included a clinical history, physical examination, chest X-ray, chemistry group, and hematology group. Patients' records were evaluated to determine the first test(s) to identify disease recu rrence, whether the recurrence was diagnosed at the time of routine fo llow-up or between scheduled follow-up evaluations, the sites of recur rence, and patient outcome. RESULTS. Recurrences occurred in 56 patien ts (49%) in the first follow-up year, 51 (44%) in the second year, and 8 (7%) after 2 years. Recurrences were signaled by clinical histories in 71% of patients, by physical examinations in 10%, chest X-rays in 12%, and abnormal chemistry testing in 6%. Although 41% of recurrences were detected at scheduled clinical visits, 59% of patients had disea se recurrence signaled by symptoms that prompted interval visits betwe en scheduled appointments. At last follow-up, all the patients in this study had died (median survival, 115 days [range, 1-793 days] after d iagnosis of recurrence), supporting the lack of curative therapy for p atients with recurrent small cell lung carcinoma. CONCLUSIONS. These d ata, demonstrating that clinical histories and physical examinations a re the most fruitful means of detecting evidence of recurrent lung car cinoma, are consistent with data regarding the follow-up of other cura tively treated cancers, such as breast carcinoma and melanoma. Chest X -rays in asymptomatic patients detect recurrences in a small proportio n of patients, whereas routine blood tests appear to be of little valu e. (C) 1997 American Cancer Society.