Evidence-based follow-up in non-small cell lung cancer

Structured follow-up is an integral part of efficient care in non-small cell lung cancer (NSCLC). However, since randomized prospective clinical trials giving clear indications for an optimal follow-up algorithm are still missing, it is necessary to seek currently available evidence to determine which follow-up strategy is advisable. For this purpose, a review of the current literature has been undertaken.

There is controversy in the literature about intensity, duration and modalities of follow-up in NSCLC. While some propose a higher intensity routine follow-up during the first 4 years after treatment, followed by yearly visits up to 5 years after treatment, others prefer a high-intensity follow-up for only the first 2 years, and yearly visits thereafter life-long. Most papers insist on measuring efficiency of routine follow-up upon its impact on overall survival. Routine chest CT should be integral part of the follow-up, while PET or PET/CT only in selected situations. The 2017 European Society for Medical Oncology guidelines formulate a consensus between all these positions by recommending visits every 6 months for the first 2 years, followed by life-long yearly surveillance, while for selected high-risk patients more frequent visits should be offered.

Current evidence from the literature supports a more intense routine follow-up in NSCLC during the first 2 years after treatment, followed by less frequent regular visits life-long.