Follow-up and Surveillance of the Patient With Lung Cancer After Curative-Intent Therapy

Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines


      These guidelines are an update of the evidence-based recommendations for follow-up and surveillance of patients after curative-intent therapy for lung cancer. Particular updates pertain to whether imaging studies, health-related quality-of-life (HRQOL) measures, tumor markers, and bronchoscopy improve outcomes after curative-intent therapy.


      Meta-analysis of Observational Studies in Epidemiology guidelines were followed for this systematic review, including published studies on posttreatment outcomes in patients who received curative-intent therapy since the previous American College of Chest Physicians subject review. Four population, intervention, comparison, and outcome questions were formulated to guide the review. The MEDLINE and CINAHL databases were searched from June 1, 2005, to July 8, 2011, to ensure overlap with the search strategies used previously.


      A total of 3,412 citations from MEDLINE and 431 from CINAHL were identified. Only 303 were relevant. Seventy-six of the 303 articles were deemed eligible on the basis of predefined inclusion criteria after full-text review, but only 34 provided data pertaining directly to the subject of the questions formulated to guide this review. In patients undergoing curative-intent surgical resection of non-small cell lung cancer, chest CT imaging performed at designated time intervals after resection is suggested for detecting recurrence. It is recommended that treating physicians who are able to incorporate the patient's clinical findings into decision-making processes be included in follow-up and surveillance strategies. The use of validated HRQOL instruments at baseline and during follow-up is recommended. Biomarker testing during surveillance outside clinical trials is not suggested. Surveillance bronchoscopy is suggested for patients with early central airway squamous cell carcinoma treated by curative-intent photodynamic therapy and for patients with intraluminal bronchial carcinoid tumor who have undergone curative-intent bronchoscopic treatment with Nd:YAG laser or electrocautery.


      There is a paucity of well-designed prospective studies specifically targeting follow-up and surveillance modalities aimed at improving survival or QOL after curative-intent therapy. Additional research is warranted to clarify which curative-intent treatment modalities affect HRQOL the most and to identify patients who are at the most risk for recurrence or impaired QOL after treatment. Further evidence is needed to determine how the frequency and duration of surveillance programs that include imaging studies, QOL measurements, tumor markers, or bronchoscopy affect patient morbidity, survival, HRQOL, and health-care costs.
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lewis SZ
        • Diekemper R
        • Addrizzo-Harris DJ
        Methodology for development of guidelines for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2013; 143: 41S-50S
        • Jemal A
        • Bray F
        • Center MM
        • Ferlay J
        • Ward E
        • Forman D
        Global cancer statistics.
        CA Cancer J Clin. 2011; 61: 69-90
        • Siegel R
        • Naishadham D
        • Jemal A
        Cancer statistics, 2012.
        CA Cancer J Clin. 2012; 62: 10-29
        • Jemal A
        • Siegel R
        • Ward E
        • et al.
        Cancer statistics, 2008.
        CA Cancer J Clin. 2008; 58: 71-96
        • Sugimura H
        • Nichols FC
        • Yang P
        • et al.
        Survival after recurrent nonsmall-cell lung cancer after complete pulmonary resection.
        Ann Thorac Surg. 2007; 83: 409-417
        • Monteil J
        • Vergnenègre A
        • Bertin F
        • et al.
        Randomized follow-up study of resected NSCLC patients: conventional versus 18F-DG coincidence imaging.
        Anticancer Res. 2010; 30: 3811-3816
        • Korst RJ
        • Kansler AL
        • Port JL
        • Lee PC
        • Altorki NK
        Accuracy of surveillance computed tomography in detecting recurrent or new primary lung cancer in patients with completely resected lung cancer.
        Ann Thorac Surg. 2006; 82: 1009-1015
        • Subotic D
        • Mandaric D
        • Radosavljevic G
        • Stojsic J
        • Gajic M
        • Ercegovac M
        Relapse in resected lung cancer revisited: does intensified follow up really matter? A prospective study.
        World J Surg Oncol. 2009; 7: 87
        • Calman L
        • Beaver K
        • Hind D
        • Lorigan P
        • Roberts C
        • Lloyd-Jones M
        Survival benefits from follow-up of patients with lung cancer: a systematic review and meta-analysis.
        J Thorac Oncol. 2011; 6: 1993-2004
        • Alberts WM
        Follow up and surveillance of the patient with lung cancer: what do you do after surgery?.
        Respirology. 2007; 12: 16-21
        • Rubins J
        • Unger M
        • Colice GL
        American College of Chest Physicians. Follow-up and surveillance of the lung cancer patient following curative intent therapy: ACCP evidence-based clinical practice guideline (2nd edition).
        Chest. 2007; 132: 355S-367S
        • Stroup DF
        • Berlin JA
        • Morton SC
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Counsell C
        Formulating questions and locating primary studies for inclusion in systematic reviews.
        Ann Intern Med. 1997; 127: 380-387
        • Meade MO
        • Richardson WS
        Selecting and appraising studies for a systematic review.
        Ann Intern Med. 1997; 127: 531-537
        • Langer-Gould A
        • Popat RA
        • Huang SM
        • et al.
        Clinical and demographic predictors of long-term disability in patients with relapsing-remitting multiple sclerosis: a systematic review.
        Arch Neurol. 2006; 63: 1686-1691
        • Cox K
        • Wilson E
        • Heath L
        • Collier J
        • Jones L
        • Johnston I
        Preferences for follow-up after treatment for lung cancer: assessing the nurse-led option.
        Cancer Nurs. 2006; 29: 176-187
        • British Thoracic Society Standards of Care Committee
        BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease.
        Thorax. 2008; 63: i1-i16
        • Nakamura R
        • Kurishima K
        • Kobayashi N
        • et al.
        Postoperative follow-up for patients with non-small cell lung cancer.
        Onkologie. 2010; 33: 14-18
        • Takigawa N
        • Kiura K
        • Segawa Y
        • Okayama Lung Cancer Study Group
        • et al.
        Second primary cancer in survivors following concurrent chemoradiation for locally advanced non-small-cell lung cancer.
        Br J Cancer. 2006; 95: 1142-1144
        • Benamore R
        • Shepherd FA
        • Leighl N
        • et al.
        Does intensive follow-up alter outcome in patients with advanced lung cancer?.
        J Thorac Oncol. 2007; 2: 273-281
        • Walsh GL
        • O'Connor M
        • Willis KM
        • et al.
        Is follow-up of lung cancer patients after resection medically indicated and cost-effective?.
        Ann Thorac Surg. 1995; 60: 1563-1570
        • Pairolero PC
        • Williams DE
        • Bergstralh EJ
        • Piehler JM
        • Bernatz PE
        • Payne WS
        Postsurgical stage I bronchogenic carcinoma: morbid implications of recurrent disease.
        Ann Thorac Surg. 1984; 38: 331-338
        • Detterbeck F
        • Rivera MP
        • Socinski M
        • Rosenman J
        Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Saunders, Philadelphia, PA2001: 437-450
        • Detterbeck FC
        • Mazzone PJ
        • Naidich DP
        • Bach PB
        Screening for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2013; 143: e78S-e92S
        • Cho S
        • Lee EB
        A follow-up of integrated positron emission tomography/computed tomography after curative resection of non-small-cell lung cancer in asymptomatic patients.
        J Thorac Cardiovasc Surg. 2010; 139: 1447-1451
        • Takenaka D
        • Ohno Y
        • Koyama H
        • et al.
        Integrated FDG-PET/CT vs. standard radiological examinations: comparison of capability for assessment of postoperative recurrence in non-small cell lung cancer patients.
        Eur J Radiol. 2010; 74: 458-464
        • Gorenberg M
        • Bar-Shalom R
        • Israel O
        Patterns of FDG uptake in post-thoracotomy surgical scars in patients with lung cancer.
        Br J Radiol. 2008; 81: 821-825
        • Henderson MA
        • Hoopes DJ
        • Fletcher JW
        • et al.
        A pilot trial of serial 18F-fluorodeoxyglucose positron emission tomography in patients with medically inoperable stage I non-small-cell lung cancer treated with hypofractionated stereotactic body radiotherapy.
        Int J Radiat Oncol Biol Phys. 2010; 76: 789-795
        • Vahdat S
        • Oermann EK
        • Collins SP
        • et al.
        CyberKnife radiosurgery for inoperable stage IA non-small cell lung cancer: 18F-fluorodeoxyglucose positron emission tomography/computed tomography serial tumor response assessment.
        J Hematol Oncol. 2010; 3: 6
        • van Loon J
        • Grutters J
        • Wanders R
        • et al.
        Follow-up with 18FDG-PET-CT after radical radiotherapy with or without chemotherapy allows the detection of potentially curable progressive disease in non-small cell lung cancer patients: a prospective study.
        Eur J Cancer. 2009; 45: 588-595
        • Aokage K
        • Yoshida J
        • Nishimura M
        • Nishiwaki Y
        • Nagai K
        Annual abdominal ultrasonographic examination after curative NSCLC resection.
        Lung Cancer. 2007; 57: 334-338
        • Venuta F
        • Sciomer S
        • Andreetti C
        • et al.
        Long-term Doppler echocardiographic evaluation of the right heart after major lung resections.
        Eur J Cardiothorac Surg. 2007; 32: 787-790
        • Bini A
        • Grazia M
        • Stella F
        • et al.
        The role of somatostatin receptor scintigraphy (octreoscan) during follow-up of patients after bronchial carcinoid resection. A prospective study.
        J Cardiovasc Surg (Torino). 2005; 46: 318-319
        • Oberg K
        • Hellman P
        • Kwekkeboom D
        • Jelic S
        • ESMO Guidelines Working Group
        Neuroendocrine bronchial and thymic tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2010; 21: v220-v222
        • Martini N
        • Rusch VW
        • Bains MS
        • et al.
        Factors influencing ten-year survival in resected stages I to IIIa non-small cell lung cancer.
        J Thorac Cardiovasc Surg. 1999; 117: 32-36
        • Moore S
        • Corner J
        • Haviland J
        • et al.
        Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial.
        BMJ. 2002; 325: 1145
        • Kenny PM
        • King MT
        • Viney RC
        • et al.
        Quality of life and survival in the 2 years after surgery for non small-cell lung cancer.
        J Clin Oncol. 2008; 26: 233-241
        • Sarna L
        • Cooley ME
        • Brown JK
        • et al.
        Women with lung cancer: quality of life after thoracotomy: a 6-month prospective study.
        Cancer Nurs. 2010; 33: 85-92
        • Schulte T
        • Schniewind B
        • Walter J
        • Dohrmann P
        • Küchler T
        • Kurdow R
        Age-related impairment of quality of life after lung resection for non-small cell lung cancer.
        Lung Cancer. 2010; 68: 115-120
        • van der Voort van Zyp NC
        • Prévost JB
        • van der Holt B
        • et al.
        Quality of life after stereotactic radiotherapy for stage I non-small-cell lung cancer.
        Int J Radiat Oncol Biol Phys. 2010; 77: 31-37
        • Ozturk A
        • Sarihan S
        • Ercan I
        • Karadag M
        Evaluating quality of life and pulmonary function of long-term survivors of non-small cell lung cancer treated with radical or postoperative radiotherapy.
        Am J Clin Oncol. 2009; 32: 65-72
        • Barak V
        • Holdenrieder S
        • Nisman B
        • Stieber P
        Relevance of circulating biomarkers for the therapy monitoring and follow-up investigations in patients with non-small cell lung cancer.
        Cancer Biomark. 2010; 6: 191-196
        • Seregni E
        • Ferrari L
        • Bajetta E
        • Martinetti A
        • Bombardieri E
        Clinical significance of blood chromogranin A measurement in neuroendocrine tumours.
        Ann Oncol. 2001; 12: S69-S72
        • Cimitan M
        • Buonadonna A
        • Cannizzaro R
        • et al.
        Somatostatin receptor scintigraphy versus chromogranin A assay in the management of patients with neuroendocrine tumors of different types: clinical role.
        Ann Oncol. 2003; 14: 1135-1141
        • Blasberg JD
        • Pass HI
        • Goparaju CM
        • Flores RM
        • Lee S
        • Donington JS
        Reduction of elevated plasma osteopontin levels with resection of non-small-cell lung cancer.
        J Clin Oncol. 2010; 28: 936-941
        • D'Amico TA
        • Brooks KR
        • Joshi MB
        • et al.
        Serum protein expression predicts recurrence in patients with early-stage lung cancer after resection.
        Ann Thorac Surg. 2006; 81: 1982-1987
        • Ludovini V
        • Pistola L
        • Gregorc V
        • et al.
        Plasma DNA, microsatellite alterations, and p53 tumor mutations are associated with disease-free survival in radically resected non-small cell lung cancer patients: a study of the perugia multidisciplinary team for thoracic oncology.
        J Thorac Oncol. 2008; 3: 365-373
        • Maeda R
        • Yoshida J
        • Hishida T
        • et al.
        Late recurrence of non-small cell lung cancer more than 5 years after complete resection: incidence and clinical implications in patient follow-up.
        Chest. 2010; 138: 145-150
        • Inoue M
        • Takakuwa T
        • Minami M
        • et al.
        Clinicopathologic factors influencing postoperative prognosis in patients with small-sized adenocarcinoma of the lung.
        J Thorac Cardiovasc Surg. 2008; 135: 830-836
        • Ito T
        • Ishii G
        • Nagai K
        • et al.
        Low podoplanin expression of tumor cells predicts poor prognosis in pathological stage IB squamous cell carcinoma of the lung, tissue microarray analysis of 136 patients using 24 antibodies.
        Lung Cancer. 2009; 63: 418-424
        • Wójcik E
        • Kulpa JK
        • Sas-Korczyńska B
        • Korzeniowski S
        • Jakubowicz J
        ProGRP and NSE in therapy monitoring in patients with small cell lung cancer.
        Anticancer Res. 2008; 28: 3027-3033
        • Hoksch B
        • Fahrner R
        • Alexander Schmid R
        Procalcitonin and brain natriuretic peptide as parameters in the postoperative course of patients with major pulmonary resection [published correction in Interact Cardiovasc Thorac Surg. 2007;6(5):684].
        Interact Cardiovasc Thorac Surg. 2007; 6: 155-159
        • Egermann U
        • Jaeggi K
        • Habicht JM
        • Perruchoud AP
        • Dalquen P
        • Solèr M
        Regular follow-up after curative resection of nonsmall cell lung cancer: a real benefit for patients?.
        Eur Respir J. 2002; 19: 464-468
        • Westeel V
        • Choma D
        • Clément F
        • et al.
        Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer.
        Ann Thorac Surg. 2000; 70: 1185-1190
        • Kennedy TC
        • McWilliams A
        • Edell E
        • American College of Chest Physicians
        • et al.
        Bronchial intraepithelial neoplasia/early central airways lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
        Chest. 2007; 132: 221S-233S
        • Banerjee AK
        Preinvasive lesions of the bronchus.
        J Thorac Oncol. 2009; 4: 545-551
        • Jeremy George P
        • Banerjee AK
        • Read CA
        • et al.
        Surveillance for the detection of early lung cancer in patients with bronchial dysplasia.
        Thorax. 2007; 62: 43-50
        • Goeckenjan G
        • Sitter H
        • Thomas M
        • German Respiratory Society; German Cancer Society
        • et al.
        Prevention, diagnosis, therapy, and follow-up of lung cancer: interdisciplinary guideline of the German Respiratory Society and the German Cancer Society.
        Pneumologie. 2011; 65: 39-59
        • Nakamura H
        • Kawasaki N
        • Hagiwara M
        • et al.
        Early hilar lung cancer—risk for multiple lung cancers and clinical outcome.
        Lung Cancer. 2001; 33: 51-57
        • Ali AH
        • Takizawa H
        • Kondo K
        • et al.
        Follow-up using fluorescence bronchoscopy for the patients with photodynamic therapy treated early lung cancer.
        J Med Invest. 2011; 58: 46-55
        • Endo C
        • Miyamoto A
        • Sakurada A
        • et al.
        Results of long-term follow-up of photodynamic therapy for roentgenographically occult bronchogenic squamous cell carcinoma.
        Chest. 2009; 136: 369-375
        • Furukawa K
        • Kato H
        • Konaka C
        • Okunaka T
        • Usuda J
        • Ebihara Y
        Locally recurrent central-type early stage lung cancer < 1.0 cm in diameter after complete remission by photodynamic therapy.
        Chest. 2005; 128: 3269-3275
        • Brokx HA
        • Risse EK
        • Paul MA
        • et al.
        Initial bronchoscopic treatment for patients with intraluminal bronchial carcinoids.
        J Thorac Cardiovasc Surg. 2007; 133: 973-978
        • van Boxem TJ
        • Golding RP
        • Venmans BJ
        • Postmus PE
        • Sutedja TG
        High-resolution CT in patients with intraluminal typical bronchial carcinoid tumors treated with bronchoscopic therapy.
        Chest. 2000; 117: 125-128
        • Luckraz H
        • Amer K
        • Thomas L
        • Gibbs A
        • Butchart EG
        Long-term outcome of bronchoscopically resected endobronchial typical carcinoid tumors.
        J Thorac Cardiovasc Surg. 2006; 132: 113-115
        • van Boxem TJ
        • Venmans BJ
        • van Mourik JC
        • Postmus PE
        • Sutedja TG
        Bronchoscopic treatment of intraluminal typical carcinoid: a pilot study.
        J Thorac Cardiovasc Surg. 1998; 116: 402-406
        • Pasic A
        • Grünberg K
        • Mooi WJ
        • Paul MA
        • Postmus PE
        • Sutedja TG
        The natural history of carcinoma in situ involving bronchial resection margins.
        Chest. 2005; 128: 1736-1741
        • Peled N
        • Flex D
        • Raviv Y
        • et al.
        The role of routine bronchoscopy for early detection of bronchial stump recurrence of lung cancer: 1 year post-surgery.
        Lung Cancer. 2009; 65: 319-323
        • Aydin E
        • Yazici U
        • Gulgosteren M
        • et al.
        Long-term outcomes and prognostic factors of patients with surgically treated pulmonary carcinoid: our institutional experience with 104 patients.
        Eur J Cardiothorac Surg. 2011; 39: 549-554
        • Rea F
        • Rizzardi G
        • Zuin A
        • et al.
        Outcome and surgical strategy in bronchial carcinoid tumors: single institution experience with 252 patients.
        Eur J Cardiothorac Surg. 2007; 31: 186-191
        • Aoki T
        • Tsuchida M
        • Hashimoto T
        • Saito M
        • Koike T
        • Hayashi J
        Quality of life after lung cancer surgery: video-assisted thoracic surgery versus thoracotomy.
        Heart Lung Circ. 2007; 16: 285-289
        • Timmerman R
        • Paulus R
        • Galvin J
        • et al.
        Stereotactic body radiation therapy for inoperable early stage lung cancer.
        JAMA. 2010; 303: 1070-1076
        • Onishi H
        • Araki T
        • Shirato H
        • et al.
        Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study.
        Cancer. 2004; 101: 1623-1631
        • Langendijk JA
        • Aaronson NK
        • de Jong JM
        • et al.
        Quality of life after curative radiotherapy in Stage I non-small-cell lung cancer.
        Int J Radiat Oncol Biol Phys. 2002; 53: 847-853
        • Haasbeek CJ
        • Senan S
        • Smit EF
        • Paul MA
        • Slotman BJ
        • Lagerwaard FJ
        Critical review of nonsurgical treatment options for stage I non-small cell lung cancer.
        Oncologist. 2008; 13: 309-319
        • Lee CB
        • Stinchcombe TE
        • Moore DT
        • et al.
        Late complications of high-dose (>/=66 Gy) thoracic conformal radiation therapy in combined modality trials in unresectable stage III non-small cell lung cancer.
        J Thorac Oncol. 2009; 4: 74-79
        • Montazeri A
        • Milroy R
        • Hole D
        • McEwen J
        • Gillis CR
        Quality of life in lung cancer patients: as an important prognostic factor.
        Lung Cancer. 2001; 31: 233-240
        • Quinten C
        • Coens C
        • Mauer M
        • EORTC Clinical Groups
        • et al.
        Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials.
        Lancet Oncol. 2009; 10: 865-871
        • Temel JS
        • Greer JA
        • Muzikansky A
        • et al.
        Early palliative care for patients with metastatic non-small-cell lung cancer.
        N Engl J Med. 2010; 363: 733-742
        • Baker F
        • Denniston M
        • Smith T
        • West MM
        Adult cancer survivors: how are they faring?.
        Cancer. 2005; 104: 2565-2576
        • Aziz NM
        Cancer survivorship research: state of knowledge, challenges and opportunities.
        Acta Oncol. 2007; 46: 417-432
        • Eriksson P
        • Brattström D
        • Hesselius P
        • et al.
        Role of circulating cytokeratin fragments and angiogenic factors in NSCLC patients stage IIIa-IIIb receiving curatively intended treatment.
        Neoplasma. 2006; 53: 285-290
        • Chundong G
        • Uramoto H
        • Onitsuka T
        • et al.
        Molecular diagnosis of MACC1 status in lung adenocarcinoma by immunohistochemical analysis.
        Anticancer Res. 2011; 31: 1141-1145
        • Song SY
        • Jeong SY
        • Park HJ
        • et al.
        Clinical significance of NQO1 C609T polymorphisms after postoperative radiation therapy in completely resected non-small cell lung cancer.
        Lung Cancer. 2010; 68: 278-282
        • Ohta Y
        • Tanaka Y
        • Watanabe G
        • Minato H
        Predicting recurrence following curative surgery in stage I non-small cell lung cancer patients using an angiogenesis-associated factor.
        J Exp Clin Cancer Res. 2007; 26: 301-305
        • Kashiwabara K
        • Saeki S
        • Sasaki J
        • Nomura M
        • Kohrogi H
        Combined evaluation of postoperative serum levels of carcinoembryonic antigen less than or equal to 2.5 ng/ml and absence of vascular invasion may predict no recurrence of stage I adenocarcinoma lung cancer.
        J Thorac Oncol. 2008; 3: 1416-1420
        • Sharma P
        • Hawes RH
        • Bansal A
        • et al.
        Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial.
        Gut. 2013; 62: 15-21
        • Piazza C
        • Cocco D
        • De Benedetto L
        • Del Bon F
        • Nicolai P
        • Peretti G
        Narrow band imaging and high definition television in the assessment of laryngeal cancer: a prospective study on 279 patients.
        Eur Arch Otorhinolaryngol. 2010; 267: 409-414
        • Ohtani K
        • Lee AM
        • Lam S
        Frontiers in bronchoscopic imaging.
        Respirology. 2012; 17: 261-269
        • Pasini F
        • Pelosi G
        • Valduga F
        • et al.
        Late events and clinical prognostic factors in stage I non small cell lung cancer.
        Lung Cancer. 2002; 37: 171-177
        • Okada M
        • Nishio W
        • Sakamoto T
        • Harada H
        • Uchino K
        • Tsubota N
        Long-term survival and prognostic factors of five-year survivors with complete resection of non-small cell lung carcinoma.
        J Thorac Cardiovasc Surg. 2003; 126: 558-562
        • Filleron T
        • Barrett A
        • Ataman O
        • Kramar A
        Planning posttherapeutic oncology surveillance visits based on individual risk.
        Med Decis Making. 2009; 29: 570-579
        • Demicheli R
        • Fornili M
        • Ambrogi F
        • et al.
        Recurrence dynamics for non-small-cell lung cancer: effect of surgery on the development of metastases.
        J Thorac Oncol. 2012; 7: 723-730
        • Gustafsson BI
        • Kidd M
        • Chan A
        • Malfertheiner MV
        • Modlin IM
        Bronchopulmonary neuroendocrine tumors.
        Cancer. 2008; 113: 5-21