[Postoperative follow-up in non-small cell lung cancer]

Survival of patients after surgery for non-small cell lung cancer is significantly limited because of frequent fatal recurrences of the disease. Logically, follow-up should detect recurrences early, thus increasing chances of cure.

Only non-randomised studies have been published. These suggest that thoracic recurrences are the most frequent isolated recurrences and the most frequently treated with curative intent; and that diagnosis of recurrences while patients are still asymptomatic might improve survival. Several guidelines have been published, with follow-up programs of varying intensity and with a recent tendency to reduce follow-up procedures to clinical assessment only (American Society of Clinical Oncology 2004).

All guidelines agree that there is a need for randomised data. Only one randomised trial is ongoing, conducted by the Intergroupe Francophone de Cancérologie Thoracique (IFCT). This study compares a minimal follow-up with physical examination and chest X-ray alone to a more intensive follow-up program reflecting routine French practice which in addition includes thoracic CT scan and fibre optic bronchoscopy.

As it is not yet possible to define the optimal follow-up after surgery for non-small cell lung cancer from existing data, the IFCT randomised study represents for pulmonologists, oncologists and thoracic surgeons a good opportunity to rationalise postoperative follow-up and to defend their practice from minimalist recommendations.