Evaluation of recurrent bronchogenic carcinoma by computed tomography

Thirty-five patients with strongly suspected recurrent tumor of the lung and definitely positive computed tomography (CT) scan were reviewed. The patients had undergone surgery (group A, n = 17) or radiation therapy (group B, n = 18). TNM-staging of lung cancer in both groups revealed similar results. Small cell carcinoma (P less than 0.05), central tumors (P less than 0.003), and elderly patients (P less than 0.05) were more often found in group B. Disease-free interval was longer in patients with tumor resection (45.5 v 11.7 months, P less than 0.007) and depended on T-stage in irradiated cases (P less than 0.05). Local recurrence with or without mediastinal lymph node involvement occurred in all irradiated patients; 3 of 16 surgical patients showed isolated mediastinal lymph node enlargement without tumor relapse (not seen by plain chest roentgenographs). Plain films failed to detect nearly 20% of the space-occupying lesions, which could easily be identified by CT. In one patient the suspected tumor recurrence turned out to be a tuberculous infiltration. A second lung cancer (no tumor recurrence) was pathohistologically assumed in three of the resected cases with an interval from 10-181 mo after surgery. On the basis of these findings, CT-monitoring can be recommended when the patient is resected for cure. Some patients will benefit by an early diagnosis of a local-regional tumor recurrence when the time until the necessary secondary treatment may be shortened. Long-term survival may be achieved in a small group of these patients.