ESMO Patients Guide
What happens after my treatment has finished? Follow-up appointments
You will be able to discuss any concerns you have at your follow-up appointments
After your treatment has finished, your doctor will arrange follow-up appointments. You will have regular chest x-rays and/or CT scans to check that there are no further tumours. Your doctor will also evaluate any treatment complications or side effects related to surgery, radiotherapy and/or systemic anti-cancer treatment. The frequency of these appointments will be tailored to your situation, and will depend on the stage of the cancer when you were initially diagnosed and the treatment that you have had (Postmus et al., 2017; Planchard et al., 2018). Recommendations • After surgery for Stage I-III NSCLC, you should be seen every 6 months for the first 2 years and then yearly after that (Postmus et al., 2017). • You may have a CT scan every 6 months, particularly if you are suitable for salvage treatment should there be any complications (Postmus et al., 2017). • After treatment for metastatic disease, depending on your suitability for further treatment, your doctor will see you every 6–12 weeks so that second-line therapy can be started promptly, if needed (Planchard et al., 2018). • If you have had multimodal therapy for Stage III disease you are likely to have brain scans to monitor for the development of brain metastases, for which you may be offered treatment (Eberhardt et al., 2015). What if I need more treatment? Cancer that comes back is called a recurrence. The treatment that you will be offered depends on the extent of the recurrence. When the tumour comes back as a recurrence at a single site, you may be offered treatment such as surgical removal or radiotherapy. However, this approach is limited to a very small group of patients. Recurrent tumours are normally regarded as metastatic cancers and you can usually have further chemotherapy with different drugs, and some patients may be suitable for treatment with targeted therapies or immunotherapy (see section ‘Treatment options for metastatic (Stage IV) NSCLC’ for more information). In some cases, a repeated biopsy of the tumour may be carried out as it may result in a change to the treatment decision. This may be particularly true if you have been cancer-free for some time after surgical resection. Where available, patients who were previously treated for NSCLC with an EGFR-activating mutation may undergo a liquid biopsy to detect any T790M mutation (also called plasma EGFR mutational analysis). This will involve providing a small blood sample for analysis. Re-biopsy may be useful to differentiate between disease recurrence and a new primary lung tumour (if the recurrence is detected in the lung) to ascertain the type of tumour or to repeat the EGFR mutation test if a non-squamous cancer is detected (Planchard et al., 2018).
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