Follow Up and Surveillance of Esophageal Cancer Treated With Curative Intent

Follow Up and Surveillance of Esophageal Cancer Treated With Curative Intent

  • Authors: Anne-Sophie Laliberté, MD. FRCSC
  • Reviewers : Brian Johnston and Andrew Seely

Society recommendations

Based on society recommendations and expert consensus, there is no high level of evidence to guide in the development of algorithms.

The majority of recurrences (44%)1 occur in the first two years following cancer treatment, but some have been described up to more than 5 years after. (NCCN)

In case of squamous cell carcinoma, we need to consider the possibility of metachronous cancer.

Incidence of esophageal cancer in Canada:

In 2019, Canadian Cancer Society estimate:

  • 2,300 Canadians will receive a diagnosis of esophageal cancer
  • 2,200 Canadians will die of esophageal cancer

Society recommendations reviewed:

Canadian, American, and French guidelines and recommendations were reviewed.

  • National Comprehensive Cancer Network (2019)
  • Canadian Cancer Society (2019)
  • NICE guidelines (2018)
  • Cancer Care Ontario
  • Thesaurus recommendations (2016)
  • ESMO Clinical Practice Guidelines (2013)
  • French guidelines OncoLogik (2019)

Follow up and surveillance of surgical patient by stage and type of resection:

Clinical and Physical examination:

  • Clinical and physical examination is recommended for all stages, the frequency is variable between the different society recommendations.
  • Follow up at 3, 6, 12, 18, 24 months and then annually.
  • Smoking cessation is recommended
  • Unscheduled evaluation if patient become symptomatic

.

Early Stage – Stage I:

Abbreviations

  • EMR: Endoscopic mucosal resection
  • RFA: Radiofrequency ablation
  • ESD: Endoscopic submucosal resection

.

Advanced Stage – Stage II&III:

Recommendations:

Summary of recommendations for endoscopic and radiologic surveillance after esophageal cancer resection
Stage Endoscopic surveillance Radiologic surveillance
Stage I – Recommended for local resection only: every 3months for one year, then every 6 months for the second year and then annually

– Recommended if residual Barrett’s esophagus

– Treatment of persistent Barrett’s esophagus is recommended

– Radiologic surveillance isn’t recommended for Tis and T1a

– Annual CT-scan for 3 years is recommended for pT1b

Stage II & III – No evidence to recommend Endoscopic – CT-scan every 6 months for 2 years then annually

 

Summary of recommendations for endoscopic and radiologic surveillance after definitive chemoradiation for esophageal cancer
Stage Endoscopic surveillance Radiologic surveillance
Stage I – Endoscopic surveillance every 3-6 months for 2 years then annually – CT-scan every 6-9months if patient candidate for salvage esophagectomy
Stage II & III – Endoscopic surveillance every 3-6 months for 2 years, then every 6 months for the third year then clinically/ annually. – CT-scan every 6 months for the first 2 years if patient candidate for salvage esophagectomy, then clinically/annually.

Lifelong follow up is recommended.


Bibliograpy

Society

  • National Comprehensive Cancer Network (2019)
  • Canadian Cancer Society (2019)
  • Cancer Care Ontario
  • Thesaurus recommendations – Thésaurus National de Cancérologie Digestive (publish 23/09/2016)
  • French guidelines OncoLogik ( Esophageal adenocarcinoma :publish 14/05/2019 and Squamous cell carcinoma: publish 28/06/2018)

Articles

  1. Du Rieu M.C., Filleron T., Beluchon B. et al.Recurrence risk after Ivor Lewis oesophagectomy for cancer. Journal of Cardiothoracic Surgery 2013,8:213
  2. Mariam Naveed and Nisa Kubilium. Endoscopic Treatment of Early-Stage Esophageal Cancer. Curr Oncol Rep (2018) 20:71.
  3. Sharma, D. Katzka, N. Gupta et al. Quality Indicators for the Management of Barrett’sEsophagus, Dysplasia, and Esophageal Adenocarcinoma: Internation Consensus Recommendations from the American Gastroenterological Association Symposium. Gastroenterology. 2015;149(6):1599-1606.
  4. Stahk, C. Mariette, K. Haustermans et al. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow up. Ann Oncol 2016;27 (suppl.5):v50-57

Follow-up and Surveillance Recommendations for Patients Treated Curatively for Lung Cancer.


Background:

Despite advances in the care of patients with NSCLC, the overall 5-year survival for patients treated with curative intent remains poor. The rationale for surveillance following the treatment of lung cancer is the detection of recurrent disease or a new primary lung cancer, no randomized data exist to support specific recommendations for surveillance modality and interval. Most recommendations are based on expert consensus and cohort studies, and the effect of surveillance on survival continues to be debated. Data extrapolated from screening trials does demonstrate a survival benefit to the detection of early stage cancers and most guideline-setting groups recommend a surveillance strategy involving regular clinical examinations and imaging. 1-8, 10-16

Recommendations

  • Surveillance for early recurrence or new primaries in patients treated with curative intent for NSCLC:
    • Low dose CT chest +/- contrast q6mo in years 1 and 2 1-5,9,17,18
    • Low dose CT chest +/- contrast q12mo years thereafter1-5,9,17,18
  • CT dose (i.e. Low dose vs Minimal dose) and the use of contrast is controversial. There are no data to suggest one dose over another. Extrapolation of data from the National Lung Cancer Screening Trial would suggest Low dose CT provides good sensitivity for the detection of early stage cancers.4,5,6
  • Surveillance for early recurrence or new primaries in patients treated with curative intent for SCLC:
  • Surveillance recommendations for surveillance post curative intent treatment of SCLC are based on expert consensus and parallel those for NSCLC.
  • Contrast enhanced CT chest may provide superior assessment of mediastinal nodal involvement18

References

  1. Calman L, Beaver K, Hind D, Lorigan P, Roberts C, Lloyd-Jones M. Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis. J Thorac Oncol. 2011;6(12):1993-2004.
  2. Sugimura H, Yang P. Long-term survivorship in lung cancer: a review. Chest.2006;129(4):1088-97
  3. Srikantharajah D, Ghuman A, Nagendran M, Maruthappu M. Is computed tomography follow-up of patients after lobectomy for non-small cell lung cancer of benefit in terms of survival? Interact Cardiovasc Thorac Surg. 2012;15(5):893-8.
  4. Hanna WC, Paul NS, Darling GE, Moshonov H, Allison F, Waddell TK, et al. Minimal-dose computed tomography is superior to chest x-ray for the follow-up and treatment of patients with resected lung cancer. J Thorac Cardiovasc Surg. 2014;147(1):30-5.
  5. National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013;368(21):1980-91.
  6. Crabtree TD, Puri V, Chen SB, et al. Does the method of radiologic surveillance affect survival after resection of stage I non-small cell lung cancer? J Thorac Cardiovasc Surg 2015;149:45-52, 53 e41-43.
  7. Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med. 2013;369(10):920-31.
  8. Erb CT, Su KW, Soulos PR, et al. Surveillance practice patterns after curative intent therapy for stage I non-small-cell lung cancer in the medicare population. Lung Cancer 2016;99:200-207. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27565940.
  9. Colt HG, Murgu SD, Korst RJ, et al. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143:e437S-454S. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23649451.
  10. Lou F, Huang J, Sima CS, et al. Patterns of recurrence and second primary lung cancer in early-stage lung cancer survivors followed with routine computed tomography surveillance. J Thorac Cardiovasc Surg 2013;145:75-81; discussion 81-72. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23127371.
  11. Srikantharajah D, Ghuman A, Nagendran M, Maruthappu M. Is computed tomography follow-up of patients after lobectomy for non-small cell lung cancer of benefit in terms of survival? Interact Cardiovasc Thorac Surg 2012;15:893-898. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22859511.
  12. Dane B, Grechushkin V, Plank A, et al. PET/CT vs. non-contrast CT alone for surveillance 1-year post lobectomy for stage I non-small-cell lung cancer. Am J Nucl Med Mol Imaging
  13. Nakamura R, Kurishima K, Kobayashi N, et al. Postoperative follow-up for patients with non-small cell lung cancer. Onkologie. 2010;33(1-2):14-18
  14. Johnson BE. Second lung cancers in patients after treatment for an initial lung cancer. J Natl Cancer Inst 1998; 90: 1335–1345.
  15. Demicheli R, Fornili M, Ambrogi F et al. Recurrence dynamics for non-small-cell lung cancer: effect of surgery on the development of metastases. J Thorac Oncol 2012; 7: 723–730.
  16. Toba H, Sakiyama S, Otsuka H et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography is useful in postoperative follow-up of asymptomatic non-small cell lung cancer patients. Interact Cardiovasc Thorac Surg 2012; 15: 859–864
  17. Vansteenkiste, et al. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Annals of Oncology 25: 1462–1474, 2014
  18. Ung YC, Souter LH, Darling G, Dobranowski J, Donohue L, Leighl N, et al. Follow-up and surveillance of curatively treated lung cancer patients. Toronto (ON): Cancer Care Ontario; 2014 Aug 29. Program in Evidence-Based Care Evidence-Based Series No.: 26-3.