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
- primary care
- high resolution
- radiation therapy
- chronic kidney disease
- computed tomography
- ejection fraction
- peritoneal dialysis
- small cell lung cancer
- newly diagnosed
- healthcare
- locally advanced
- smoking cessation
- magnetic resonance imaging
- magnetic resonance
- stem cells
- squamous cell carcinoma
- clinical trial
- emergency department
- study protocol
- blood brain barrier
- fluorescence imaging
- clinical practice
- mesenchymal stem cells
- positron emission tomography
- rheumatoid arthritis
- brain injury
- multiple sclerosis
- mental health
- white matter
- phase ii
- cross sectional
- image quality
- cardiac resynchronization therapy