CT surveillance, patterns of recurrence and eligibility for salvage therapy after curative intent treatment for unresectable stage III non small cell lung cancer

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INTRODUCTION: Survival rates of unresectable stage III non-small cell lung cancer (NSCLC) have improved with the introduction of durvalumab following chemoradiotherapy. Post-treatment surveillance remains crucial due to the high relapse rate, and early detection of recurrence may allow for more effective salvage therapies. This study evaluated CT imaging frequency post-chemoradiotherapy, patterns of disease recurrence, and the feasibility and impact of salvage therapies. METHODS: Patients with unresectable stage III NSCLC treated at BC Cancer, British Columbia, Canada from January 2018-December 2021 were identified. A retrospective chart review was performed including patient characteristics, imaging surveillance, treatment, recurrence patterns, number of sites of metastases and salvage treatment. RESULTS: 433 Patients received curative intent chemoradiotherapy+/-durvalumab and 63% experienced recurrence; 43% had oligorecurrence (1-5 metastases), and 57% had high volume recurrence (>5 metastases). CT surveillance rates varied with 3-16% of progression events detected in 3-month intervals within the first two years. For patients with extracranial+/-CNS oligorecurrence, at next follow up imaging 64% remained in an oligorecurrent state with treatment (median 4.6 m) and 57% without treatment (median 3.05 m). 33% oligorecurrent patients received MDT; the most common reason for not receiving MDT was in field recurrence. CONCLUSIONS: Regular radiographic imaging every 3 months can detect early recurrence that may be amenable to ablative therapy. A significant proportion of patients remain oligoprogressive at next imaging indicating a window for potential MDT. The use of ablative treatment for oligorecurrence was feasible in the real world with 33% of our population receiving MDT.

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