LATE-BREAKING ABSTRACT: Early relapse of non-small cell lung cancer (NSCLC) found after CNS-symptoms

Background: Danish guidelines have since February 2014 recommended MR of the brain prior to curative radiotherapy in patients with NSCLC and N2-disease. More recently O'Dowd et al. [Lung Cancer 86 (2014) 185–189] have suggested MR of the brain prior to surgery no matter the stage.Aim: To study whether the introduction in 2010 of follow-up by CT of thorax and upper abdomen every three months has reduced the incidence of relapse suspected from CNS-symptoms.Results: All 827 NSCLC patients from Funen completing curative treatment from 2005 to 2013 were included. The total number of relapses found after symptoms within 24 months decreased in the 3½ years after the introduction of CT-based follow-up, p < 0,001 (table), but the total fraction presenting with CNS-symptoms did not change, p = 0.296. Relapses after stage I cancer decreased (p = 0.025), while no differences or changes for stages II or III were found.Conclusion: CT-based follow-up has not reduced the incidence of relapse suspected from CNS-symptoms in stage II-IV, and therefore we suggest routine MR of the brain before curative treatment for this group of patients.Number, fractions(%), and [95%CI]Jan. 2005 - June 2010July 2010 - Dec. 2013Patients with intended curative treatment449378Relapse within 24 months172 (38.3%) [33.8-43.0%]155 (41.0%) [36.0-46.2%]Relapse suspected from symptoms118 (26.3%) [22.3-30.6%]49 (13.0%) [9.8-16.8%]Relapse suspected from CNS-symptoms30 (6.7%) [4.6-9.4%]18 (4.8%) [2.9-7.4%]- Stage I9 (4.1%) [1.9-7.7%]1 (0.6%) [0.0-3.0%]- Stage II7 (7.0%) [2.9-13.9%]6 (6.7%) [2.5-14.1%]- Stage III13 (10.7%) [5.8-17.5%]8 (9.0%) [4.0-17.0%]- Stage IV - with initial brain metastases1 (16.7%) [4.2-64.1%]3 (50.0%) [11.8-88.2%]