Feiran Lou1, Inderpal Sarkaria2, Catherine Pietanza3, William Travis4, Mee Sook Roh5, Gabriel Sica6, David Healy7, Valerie Rusch2, James Huang8. 1. Department of Surgery, SUNY Downstate Medical Center, Brooklyn, New York. 2. Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York. 3. Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. 4. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York. 5. Department of Pathology, Dong-A University College of Medicine, Busan, Republic of Korea. 6. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia. 7. Department of Cardiothoracic Surgery, St. Vincent's University Hospital, Dublin, Ireland. 8. Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: huangj@mskcc.org.
Abstract
BACKGROUND: The current guidelines for follow-up care after treatment of non-small cell lung cancer recommend continued surveillance for detection of recurrent or metachronous disease. However, carcinoid tumors, especially those with a typical histologic profile, tend to be less aggressive. Our goal was to determine the patterns of relapse and the manner of detection of recurrences, to guide follow-up care after resection. METHODS: Patients who underwent operations for pulmonary carcinoids at our institution were identified from a prospectively maintained database, and their medical records were reviewed for relapse patterns, detection methods, and outcomes. RESULTS: A total of 337 patients who underwent resection between 1993 and 2010 were included, with a median follow-up time of 3.5 years. Typical and atypical carcinoids were present in 291 (86%) and 46 (14%) patients, respectively. Recurrences occurred in 21 patients (6%), with distant metastases in 20 patients (95%) and locoregional recurrence in only 1 patient. Most recurrences (15 [76%]) were not detected through scheduled surveillance imaging but after the presentation of symptoms (7 [33%]) or incidentally by studies performed for unrelated reasons (8 [38%]). The risk of recurrence increased with positive lymph nodes and atypical histologic type. Only 9 of 291 patients (3%) with typical carcinoids experienced recurrences, with a median time to recurrence of 4 years (range, 0.8-12 years). Conversely, 12 of 46 patients (26%) with atypical carcinoids experienced recurrences, with a median time to recurrence of 1.8 years (range, 0.2-7 years). CONCLUSIONS: After complete resection, scheduled surveillance imaging failed to detect most recurrences. Recurrence was rare in patients with node-negative typical carcinoids. Given the low risk of recurrence and the unclear efficacy of surveillance imaging, routine surveillance imaging may not be warranted in this cohort.
BACKGROUND: The current guidelines for follow-up care after treatment of non-small cell lung cancer recommend continued surveillance for detection of recurrent or metachronous disease. However, carcinoid tumors, especially those with a typical histologic profile, tend to be less aggressive. Our goal was to determine the patterns of relapse and the manner of detection of recurrences, to guide follow-up care after resection. METHODS:Patients who underwent operations for pulmonary carcinoids at our institution were identified from a prospectively maintained database, and their medical records were reviewed for relapse patterns, detection methods, and outcomes. RESULTS: A total of 337 patients who underwent resection between 1993 and 2010 were included, with a median follow-up time of 3.5 years. Typical and atypical carcinoids were present in 291 (86%) and 46 (14%) patients, respectively. Recurrences occurred in 21 patients (6%), with distant metastases in 20 patients (95%) and locoregional recurrence in only 1 patient. Most recurrences (15 [76%]) were not detected through scheduled surveillance imaging but after the presentation of symptoms (7 [33%]) or incidentally by studies performed for unrelated reasons (8 [38%]). The risk of recurrence increased with positive lymph nodes and atypical histologic type. Only 9 of 291 patients (3%) with typical carcinoids experienced recurrences, with a median time to recurrence of 4 years (range, 0.8-12 years). Conversely, 12 of 46 patients (26%) with atypical carcinoids experienced recurrences, with a median time to recurrence of 1.8 years (range, 0.2-7 years). CONCLUSIONS: After complete resection, scheduled surveillance imaging failed to detect most recurrences. Recurrence was rare in patients with node-negative typical carcinoids. Given the low risk of recurrence and the unclear efficacy of surveillance imaging, routine surveillance imaging may not be warranted in this cohort.
Authors: Yanding Zhao; Frederick S Varn; Guoshuai Cai; Feifei Xiao; Christopher I Amos; Chao Cheng Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-11-15 Impact factor: 4.254
Authors: Anne-Leen Deleu; Annouschka Laenen; Herbert Decaluwé; Birgit Weynand; Christophe Dooms; Walter De Wever; Sander Jentjens; Karolien Goffin; Johan Vansteenkiste; Koen Van Laere; Paul De Leyn; Kristiaan Nackaerts; Christophe M Deroose Journal: EJNMMI Res Date: 2022-05-07 Impact factor: 3.434