Post-therapeutic positron emission tomography/computed tomography for early detection of non-small cell lung cancer recurrence

Patients after curative treatment of non-small cell lung cancer (NSCLC) have a high risk of loco-regional and/or distant tumor recurrence, especially within the first two years. Timely and accurate detection of recurrence is crucial in order to start salvage or palliative therapies with the overall goal of increasing patients’ survival and quality of life. However, with the emerging use of non-surgical curative-intended therapies, follow-up of patients becomes even more challenging, as local recurrence has to be distinguished from various post-therapeutic changes at the site of the primary cancer. Integrated positron emission tomography/computed tomography (PET/CT), which is already an established imaging modality in the staging of NSCLC, is increasingly used in recurrence surveillance algorithms. By detailed morphological information being combined with additional information about the metabolic activity of suspicious sites, determination of suspicious lesions as benign or malignant can be improved. This article reviews the value of integrated PET/CT in assessing recurrence in NSCLC patients after potentially curative surgery and after curative-intended non-surgical therapies and raises as well the issue of cost-effectiveness of PET/CT for follow-up.