How do you follow patients after SBRT for NSCLC?

Which imaging studies do you perform and what is the timing after treatment?

2 Answers

Mednet MemberInvited Expert

Radiation Oncology · Cleveland Clinic

Answered on

When we started our lung SBRT practice almost 13 years ago, the follow up schedule was based on trying to measure the benefits and impact of the therapy in a fairly structured fashion so that we could develop expertise in understanding outcomes, radiographic changes, patient experience, and treatment-related toxicity. Thus, we did an initial "toxicity" check at around 6 weeks after SBRT with a combination of CT chest without contrast, spirometry, and DLCO. Thereafter, patients were seen in follow up every 3 months for 2 years with a CT chest without contrast at each visit and PFTs twice yearly. This has remained the informal structure to our SBRT patients since then, mainly by virtue of "tradition". With experience, we learned to rarely use PET for follow up and assessment, and only to reserve it until we were quite sure there was a possibility of recurrence locally, or else with new findings on CT of regional or distant recurrence. In patients who showed early CRs to therapy, we would switch quickly to 6-monthly surveillance follow ups. There is a poster at ASTRO 2017 based on a consensus study of lung SBRT experts addressing this very topic and should be therefore of interest to the Mednet readership

Mednet Member

Radiation Oncology · Radiation Oncology Associates PA

Answered on

At my hospital, our routine practice is to see all patients around one month after completing treatment. I agree with @Dr. First Last that for SBRT patients that six weeks is just fine.

I'll usually see patients back every three months with chest CTs for two visits then space it to every four to six months until two years. That way I see them when radiation pneumonitis is a higher risk, but usually these patients are frail and often are seeing other physicians so it's easier on the patient and they know to call me if they have any new symptoms. I ensure the patient continues to see a pulmonologist and defer the decision on PFTs to the pulmonologist if the patient is stable symptomatically.

At two years, I'll transition to every 6 month visits/CTs and continue until five years. I don't have @Dr. First Last's experience but plan on annual followup/CT, or ensure annual followup with pulmonary medicine/PCP if they patient won't keep coming to see me.