[Follow up of non small cell lung cancer. Should patients be followed up after surgery for non-small cell lung cancer and how?].

INTRODUCTION

Survival of patients after surgery for non-small cell lung cancer is significantly impaired because of frequent fatal recurrences. Logically, follow-up should detect early recurrences, thus increasing chances of cure.

STATE OF THE ART: Only nonrandomized studies have been published. These data show that: thoracic recurrences are the most frequent and the most frequently treated with curative intent; diagnosis of recurrences while patients are still asymptomatic might improve survival. Several guidelines have been published, with follow-up programs of variable intensity and with a recent tendency to reduce follow-up procedures to the only clinical visit with medical history and physical examination (American Society of Clinical Oncology, 2004).

PERSPECTIVES: All these recommendations consider that there is a need for randomized data. Only one randomized trial is ongoing, conducted by the Intergroupe Francophone de Cancérologie Thoracique (IFCT). This study compares a minimal follow-up with physical examination and chest X-ray and a more intensive follow-up program reflecting the French everyday practice including physical examination, chest X-ray, thoracic CT scan and fiberoptic bronchoscopy.

CONCLUSION

Follow-up might be interesting for patients operated on for a NSCLC. Its modality remain to be defined. As it is not possible to define the optimal follow-up after surgery for non-small cell lung cancer from existing data, the IFCT randomized study represents for pulmonologists, oncologists and thoracic surgeons a good opportunity to rationalize postoperative follow-up.