Follow-up CT scans - 1289910

Hi Judy,

There really isn't an established protocol for these situations, it's more of a judgment call for the oncologist, taking into account tge patient's preferences. Dr Gadgeel (with additional input from Dr. West in the comments) discusses the issue here: http://cancergrace.org/lung/2008/08/10/fu-after-resection/

JimC
Forum moderator

Hey Judy,

Though not directed at post treatment Dr. West had this to say about contrast v no contrast, "I agree that CT scans with contrast are often ideal but not necessarily necessary, especially to follow disease that you've already identified. Chest lesions are often perfectly manageable to follow without contrast. Liver lesions are often easier to follow with contrast, but you can generally get a decent sense of things from a non-contrast CT, or else you could potentially do a PET/CT to get more information without contrast -- though I generally follow metastatic disease with conventional CT scans and not PET scans... Overall, though, I can't recall having a patient in whom I just didn't think I could adequately assess the extent of disease because of a lack of ability to give contrast." http://cancergrace.org/forums/index.php?topic=6666.0

On a personal note, Don doesn't get contrast with his CTs because it's now difficult to get a vein in his arms since all the chemo. Oncologist doesn't worry he's missing anything. I don't worry because there are several examples of our faculty who state similar sentiment about not using contrast. Remember Don has radiation, chemo and surgery as well. I'll look around for other examples.

Are you getting or not getting contrast with the CTs? Do you worry that the radiated field is difficult to read? I know Don's chest is a mess since the cancer and treatment/procedures. Another bit of info, screening CTs for high risk people who haven't had lung cancer are done with low res no contrast.

All best,
Janine

Don just told me he worried the first time he got CT without contrast. Scanxiety comes in stages. Speaking of which Don's last scan, this fall, snicked up on him and he only got 24 hours of scanxiety. I was really happy for him.

I found a piece on follow up scans for post radical curitive treatment for stage III nsclc. They note OS is higher when followed with CT vs x ray to catch a recurrence. and treating a recurrence increased OS so proved it's worth.
The thing that I think will help give you peace that you'll get a thorough reading is low res CT scanning worked as well as high res in catching recurrence. In the study that proved screening high risk people was beneficial, they put curatively treated nsclc survivors in the study pool. That study compared high and low res CT and found low to be as good at spotting nodules as high res was. It doesn't mention in this piece but those screening studies didn't use contrast. This info comes from the "Long term surveillance after radical lung cancer treatment" section of
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549483/
I believe the author/s are making an argument for a study to compare low dose ct to x ray for follow up.
It looks like the piece was written in 2015 in light of the studies that show CTs to be beneficial for high risk individuals. Hum.

Hi Judy,

I'm sorry to hear this, and I hope that it's not what it appears to be. We will look forward to a reassuring report from your meeting on Thursday.

JimC
Forum moderator

I'm going with it being a smudge and will keep my fingers crossed until we hear back. I want to reprimand you and your onc for letting you see the CD without consultation but I know how that goes. I once had that opportunity and took it.

Holding my breath,
Janine