Follow-Up Imaging Guidelines for Patients with Stage III Unresectable NSCLC: Recommendations Based on the PACIFIC Trial.
Jenny J KoShantanu O BanerjiNormand BlaisAnthony BradeCathy ClellandDevin SchellenbergStephanie SnowPaul Wheatley-PriceRen YuanBarbara L MeloskyPublished in: Current oncology (Toronto, Ont.) (2023)
The PACIFIC trial showed a survival benefit with durvalumab through five years in stage III unresectable non-small cell lung cancer (NSCLC). However, optimal use of imaging to detect disease progression remains unclearly defined for this population. An expert working group convened to consider available evidence and clinical experience and develop recommendations for follow-up imaging after concurrent chemotherapy and radiation therapy (CRT). Voting on agreement was conducted anonymously via online survey. Follow-up imaging was recommended for all suitable patients after CRT completion regardless of whether durvalumab is received. Imaging should occur every 3 months in Year 1, at least every 6 months in Year 2, and at least every 12 months in Years 3-5. Contrast computed tomography was preferred; routine brain imaging was not recommended for asymptomatic patients. The medical oncologist should follow-up during Year 1 of durvalumab therapy, with radiation oncologist involvement if pneumonitis is suspected; medical and radiation oncologists can subsequently alternate follow-up. Some patients can transition to the family physician/community primary care team at the end of Year 2. In Years 1-5, patients should receive information regarding smoking cessation, comorbidity management, vaccinations, and general follow-up care. These recommendations provide guidance on follow-up imaging for patients with stage III unresectable NSCLC whether or not they receive durvalumab consolidation therapy.
Keyphrases
- end stage renal disease
- high resolution
- primary care
- computed tomography
- newly diagnosed
- chronic kidney disease
- radiation therapy
- smoking cessation
- healthcare
- small cell lung cancer
- ejection fraction
- prognostic factors
- clinical trial
- clinical practice
- peritoneal dialysis
- stem cells
- locally advanced
- randomized controlled trial
- patient reported outcomes
- emergency department
- squamous cell carcinoma
- rheumatoid arthritis
- multiple sclerosis
- advanced non small cell lung cancer
- magnetic resonance
- positron emission tomography
- mental health
- image quality
- rectal cancer
- palliative care
- brain injury
- systemic sclerosis
- radiation induced