Diagnostic challenges in survivors of early stage lung cancer

Survivors of early stage non-small cell lung cancer (NSCLC) are at risk of developing disease recurrence, as well as new lung tumors. Distinguishing metastatic disease from a second primary lung tumor (SPLC) is important, but can pose diagnostic challenges in what are often frail patients.

We highlight three long-term survivors of early stage NSCLC who developed multiple new lung lesions on long-term follow-up after undergoing an initial stereotactic ablative radiotherapy procedure.

New radiological lesions were always evaluated by a multidisciplinary tumor board in order to determine the optimal diagnostic procedure and treatment. When identical histological types were identified, array comparative genomic hybridization (CGH) was used to differentiate between metastases and a second primary tumor. When a tissue diagnosis is not possible, a validated calculator of tumor probability can be used to calculate the likelihood of malignancy. All patients underwent multiple episodes of curative radiotherapy.

These long-term survivors of early stage NSCLC highlight the importance of radiological follow-up, and describe approaches for guiding diagnostic and therapeutic management.