Evaluation of recurrent bronchogenic carcinoma by computed tomography

Thirty-five patients with strongly suspected recurrent tumor of the lung and definitely positive computed tomography (CT) scan were reviewed. The patients had undergone surgery (group A, n = 17) or radiation therapy (group B, n = 18). TNM-staging of lung cancer in both groups revealed similar results. Small cell carcinoma (P < 0.05), central tumors (P < 0.003), and elderly patients (P < 0.05) were more often found in group B. Disease-free interval was longer in patients with tumor resection (45.5 v 11.7 months, P < 0.007) and depended on T-stage in irradiated cases (P < 0.05). Local recurrence with or without mediastinal lymph node involvement occurred in all irradiated patients; 3 of 16 surgical patients showed isolated mediastinal lymph node enlargement without tumor relapse (not seen by plain chest roentgenographs). Plain films failed to detect nearly 20% of the space-occupying lesions, which could easily be identified by CT. In one patient the suspected tumor recurrence turned out to be a tuberculous infiltration. A second lung cancer (no tumor recurrence) was pathohistologically assumed in three of the resected cases with an interval from 10–181 mo after surgery. On the basis of these findings, CT-monitoring can be recommended when the patient is resected for cure. Some patients will benefit by an early diagnosis of a local-regional tumor recurrence when the time until the necessary secondary treatment may be shortened. Long-term survival may be achieved in a small group of these patients.