Follow-up of patients with resected thoracic malignancies

Our plain-English summary of Follow-up of patients with resected thoracic malignancies, by P.M. Claiborne, C.S. Fowler, A.A. Vaporciyan (Thoracic Surgery Clinics, 2012).

The study

• Authors: P.M. Claiborne, C.S. Fowler, A.A. Vaporciyan
• Journal: Thoracic Surgery Clinics
• Published: 2012;22(1):123-31, viii
• Type of article: Review
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The authors have systematically performed a literature search using 8 databases identifying established guidelines for follow-up after resected thoracic malignancies. Seven different societies' (found to have published recommendations for non-small cell lung cancer, esophageal cancer, thymoma, or mesothelioma) guidelines are reviewed in this article. High-quality evidence leading to consistent, strong recommendations among societies has not been found. With the subsequent advancements in surgical treatment and other curative modalities, the ability to detect and intervene with curative therapy at earlier stages of disease in a growing portion of the current patient population will benefit from higher-quality evidence.

Published by Elsevier Inc.

In plain English

This was a review of published guidelines, not a new study of patients. The authors searched 8 databases for guidelines on follow-up after surgery for thoracic cancers. They reviewed recommendations from bodies including the American College of Chest Physicians (ACCP) and the European Society for Medical Oncology (ESMO). The review covered non-small cell lung cancer, esophageal cancer, thymoma, chest wall tumors and malignant pleural mesothelioma. For patients with resected non-small cell lung cancer who had adequate pulmonary function and performance, the ACCP recommended a history, physical examination and a chest radiograph or CT scan every 6 months for 2 years, then yearly. NICE and SIGN found no high-quality evidence and gave recommendations based on expert opinion. For malignant pleural mesothelioma, ESMO recommended follow-up with CT and clinical evaluation on a symptomatic basis. The authors reported no uniform consensus on screening for, or detecting recurrence of, this disease in high-risk or asbestos-exposed people. The review did no new research on asbestos exposure. The authors concluded that, until reliable evidence exists, follow-up will vary among institutions and offer inconsistent benefits. The review did not directly address cost-effectiveness.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published clinical guidelines on follow-up after surgery for thoracic cancers, based on a literature search of 8 databases, with selected supporting studies
• Who was studied: Follow-up guidelines from professional bodies, including ACCP, NCCN, the American College of Radiology, SIGN, ESMO and NICE, for patients after surgery for non-small cell lung cancer, esophageal cancer, thymoma, chest wall tumors and malignant pleural mesothelioma
• Exposure: This was not an exposure study and did no new research on asbestos. Asbestos appeared in two places. Citing other sources, the article stated that 58% of malignant pleural mesothelioma cases in the United States are caused by asbestos exposure. It also noted that there is no uniform consensus on screening asbestos-exposed individuals.
• Main results:
  • For patients with resected non-small cell lung cancer who have adequate pulmonary function and performance, the ACCP recommended a history and physical examination and either a chest radiograph or CT every 6 months for 2 years, then annually (graded 1C)
  • The ACCP stated that blood tests, PET scanning, sputum cytology, tumor markers and fluorescent bronchoscopy have no proven benefit and are not recommended in asymptomatic patients (graded 2C)
  • NICE and SIGN could not identify high-quality evidence for follow-up after lung cancer treatment and based their recommendations on expert opinion
  • For esophageal cancer, ESMO found that evidence for scheduled follow-up after treatment does not exist, except when later surgery after chemotherapy might be considered
  • For thymoma, the NCCN recommendations were limited to annual CT for 10 years
  • For malignant pleural mesothelioma, ESMO recommended follow-up with CT and clinical evaluation on a symptomatic basis
  • The authors reported no uniform consensus on screening for, or detecting recurrence of, malignant pleural mesothelioma in high-risk or asbestos-exposed individuals
  • Citing another study, the authors noted that a serum marker, mesothelin-related peptide, may be predictive of mesothelioma recurrence after surgery
• The authors' conclusion: The authors concluded that until consensus recommendations based on reliable literature exist, follow-up of patients after surgery for thoracic cancers will vary among institutions and offer inconsistent benefits
• Limitations the authors state:
  • The review did not directly address the cost-effectiveness of follow-up, because high-level evidence was lacking
  • The ACCP recommendations covered all curative-intent treatments and were not specific to surgical resection

Topics

Medical terms in this study, explained in our Lexicon: Non-Small Cell Lung Cancer, Esophageal Cancer, Mesothelioma.

Related studies

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• Intraoperative fluorescence imaging in thoracic surgery — A.D. Newton, J.D. Predina, et al. (2018)
• COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study — M.C. Garassino, J.G. Whisenant, et al. (2020)
• Chimeric Antigen Receptor (CAR) T-Cell Therapy for Thoracic Malignancies — S. Kiesgen, L. Chicaybam, et al. (2018)
• Progress in the Management of Advanced Thoracic Malignancies in 2017 — R. Ferrara, L. Mezquita, et al. (2018)
• I-O Optimise: a novel multinational real-world research platform in thoracic malignancies — S. Ekman, F. Griesinger, et al. (2019)

Browse more research in Thoracic Surgery Clinics, or return to medical research.