Retrospective study of 433 patients with unresectable stage III NSCLC treated with curative-intent chemoradiotherapy ± durvalumab at BC Cancer (January 2018–December 2021), evaluating CT surveillance frequency, recurrence patterns, and eligibility and use of salvage/metastasis-directed therapy (MDT).
63% of patients experienced recurrence; of those, 43% had oligorecurrence (1–5 metastases) and 57% had high-volume recurrence (>5 metastases). CT scans every 3 months captured 3–16% of progression events per interval in the first two years. Of patients with extracranial ± CNS oligorecurrence, 64% (with treatment, median 4.6 months) and 57% (without treatment, median 3.05 months) remained oligorecurrent at next imaging. Only 33% of oligorecurrent patients received MDT, most commonly limited by in-field recurrence.
Retrospective single-institution design limits generalizability. CT surveillance intervals were variable across patients, not protocol-driven. No survival outcomes (OS, PFS) are reported from salvage MDT, so the survival benefit of this approach remains unquantified.
3-month CT surveillance intervals can detect early oligorecurrence in stage III NSCLC post-chemoradiotherapy, and a meaningful proportion of patients remain oligoprogressive at follow-up imaging — offering a real-world window for ablative MDT. Clinicians should systematically evaluate oligorecurrent patients for MDT eligibility, bearing in mind that in-field recurrence is the most common barrier.
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