Post thoracotomy surgery - 1260579

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cheryldecker5953
Post thoracotomy surgery - 1260579

What's the standard procedure for after a lobectomy???? I had carboplatin taxetere and Evastin for six treatments prior to surgery. Had my surgery and all went well. Have been getting a CT scan w/o contrast every three months since the surgery. It will be a year in January. Scans all clear. What next? How long will I continue to have scans every three months? Will I never have any more contrast? What's the reason for that? I thought the contrast helped them define or see things better? When will that change? When will the Dr order another PET scan??? Feeling good at this writing but nervous we might miss something if more in depth testing isn't done. The discomfort/ pain from the thoracotomy is still prevalent but bearable. So I just need to better understand after treatment. Thank you.

JimC
Reply To: Post thoracotomy surgery

Hi Cheryl,

Great to hear that your scans have been clear! Following up after surgery with a CT every 3-4 months in the first year or two is standard procedure. As Dr. Pinder stated:

"I tend to follow the NCCN (National Comprehensive Cancer Network) guidelines for follow-up of lung cancer patients. For the first 2 years, NCCN recommends history, physical and contrast CT chest every 4-6 months (I usually obtain them every six months). After that, annual non-contrast enhanced CTs are recommended by the NCCN. One of the reasons for following early stage lung cancer patients with CT is not only to diagnose a potentially curable recurrence but also to make sure that a new, separate lung cancer has not developed." - http://cancergrace.org/forums/index.php?topic=1721.msg10113#msg10113

In the next message in that thread, Dr. West agreed:

"The fact is that none of the surveillance plans is proven by any hard evidence to be a better regimen than another (hence the differences among institutions and doctors), and some do favor chest x-rays. I agree that CT scans provide far, far more information, and my approach is to generally do a CT every 4 months in the first year, then every 6 months until 4 years out, and then annually. As Dr. Pinder noted, the value of these scans is partly to monitor for recurrence and partly to screen for a possible new cancer, since someone who has developed a prior lung cancer is at higher risk for a new one than someone who has never developed a lung cancer before.

My approach is still potentially modified by the circumstances of an individual patient. For instance, for the few patients I follow after surgery for a resected stage IA NSCLC, I generally do scans every 6 months instead of every 4 months in the first year, because the risk of recurrence is so much lower." - http://cancergrace.org/forums/index.php?topic=1721.msg10153#msg10153

[continued in the next post]

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

JimC
Reply To: Post thoracotomy surgery

You would need to ask your doctor his specific reason for not using contrast, but as you can see from Dr. West's comments, even a chest X-ray is considered appropriate for follow-up, and a non-contrast CT provides more information than an X-ray. A PET scan was done for initial staging, but most oncologists do not use them for follow-up, as the CT provides sufficient information.

You can read Dr. Gadgeel's post on follow-up after surgery here: http://cancergrace.org/lung/2008/08/10/fu-after-resection/

Best wishes for continued clear scans!

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: Post thoracotomy surgery

The guidelines are really well described in the links here, but there's a lot of latitude in the recommendations of different doctors. A non-contrast chest CT is a low radiation approach that still provides a lot of information to screen for a local recurrence. It's really a very reasonable approach, though as Jim noted, if you want to get details on the reasoning for the strategy selected by your doctor, your doctor is the person to ask.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education