FORT LAUDERDALE, Fla--One of the most debated topics of the preliminary
practice guidelines prepared by the National Comprehensive Cancer
Network (NCCN) has been the level of surveillance after treatment,
and this was also the case with the preliminary guideline for
small-cell lung cancer (SCLC), presented by George D. Demetri,
MD, at the NCCN's first annual conference.
The NCCN is a coalition of 15 major US cancer centers that have
come together to develop practice guidelines and perform outcomes
research (see article).
In patients who have a complete response to initial therapy, the
SCLC panel (see Table 1 for a list of the members) felt that frequent
surveillance is justified, since 5-year survival, although quite
small, is not zero, said Dr. Demetri, of the Dana-Farber Cancer
A physician in the audience from the Fred Hutchinson Cancer Center
said that surveillance in complete responders might be "overkill,
since once the patient recurs, there isn't much that can be done."
He suggested that physicians should be guided by the patient's
Dr. Demetri acknowledged that this recommendation had been the
subject of much discussion among panel members, especially in
light of the breast cancer panel's attempt to pare down surveillance.
"But," he said, "we were struck with the fact that
if these patients were going to be palliated, the next level of
treatment would probably have to start before they had terrible
symptoms or liver dysfunction, which might preclude effective
palliation, salvage, or entry into a clinical trial."
A researcher from the Mayo Clinic stated that an abstract to be
presented at the upcoming American Society of Clinical Oncology
(ASCO) meeting will shed some light on whether such follow-up
is useful in complete responders.