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Purpose The use of computed tomography (CT) for routine surveillance to detect recurrence in patients with Wilms tumor (WT) has increased in recent years. The utility of CT, despite increased risk and cost, to improve outcome for these patients is unknown. We conducted a retrospective analysis with patients enrolled in the fifth National Wilms Tumor Study (NWTS-5) to determine if surveillance with CT correlates with improved overall survival (OS) after recurrence compared with chest x-ray (CXR) and abdominal ultrasound (US). Patients and Methods Overall, 281 patients with recurrent unilateral favorable-histology WT were reviewed to assess how WT recurrence was detected: sign/symptoms (SS), surveillance imaging (SI) with CT scan, or SI with CXR/US. Results The estimated 5-year OS rate after relapse was 67% (95% CI, 61% to 72%). Twenty-five percent of recurrences were detected with SS; 48.5%, with CXR/US; and 26.5%, with CT. Patients with SS had a 5-year OS rate of 59% (95% CI, 46% to 72%) compared with 70% (95% CI, 63% to 77%; P = .23) for those detected by SI. Recurrences detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with SS (0.91 years) or CXR/US (0.86 years; P = .003). For recurrences detected by SI, more tumor foci at relapse ( P < .001) and size of the largest focus greater than 2 cm ( P = .02) were associated with inferior OS. However, there was no difference in OS after relapse when recurrence was detected by CT versus CXR/US (5-year OS rate, 65% v 73%; P = .20). Conclusion In patients with favorable-histology WT, elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health care costs.

Lung cancer is the leading cause of cancer death worldwide. Recurrence rates at all stages are high, but evidence-based post-treatment surveillance imaging strategies to detect recurrence are poorly defined, and salvage options are frequently limited. A number of national and international oncology guidelines address post-treatment imaging, but are largely based on low-level, retrospective evidence because of a paucity of high-quality data, particularly in regard to cost-effectiveness and quality-of-life endpoints. Given the lack of randomized data addressing appropriate surveillance imaging modality and interval following definitive treatment of lung cancer, there remains an unmet clinical need. Meaningful surveillance endpoints should include the financial impact, patient quality-of-life outcomes, and access-to-care issues associated with intensive follow-up to ensure that guidelines reflect quality and sustainability. A need for prospective randomized data on the subject of imaging surveillance after definitive local therapy remains an unmet need, and an opportunity for collaboration and further research.

© 2015 Wolters Kluwer Health, Inc. All rights reserved. Objective: The aim of this study was to determine the prevalence of incidental ascending aortic dilation and its significance over time in 55-to 80-year-olds undergoing routine computed tomographic scans. METHODS: Chest computed tomography reports for 64,092 patients who met the inclusion criteria were used to determine the prevalence of incidental ascending aortic dilation (4-5 cm) and, when possible, aortic growth rates. A chart review was performed to identify any aortic complication or intervention. RESULTS: The prevalence of incidental aortic dilation was 2.7% (671/24,992 patients). Of the 327 patients with aortic dilation and follow-up studies (mean, 3.4 years), only 3.7% (n = 12) demonstrated interval growth (mean of 0.9 mm/y). No patient underwent prophylactic surgery or intervention on the basis of aortic size or growth rate. One patient developed a type A dissection. CONCLUSIONS: Current guidelines for yearly surveillance imaging of aortic dilation could be revised to increase the follow-up interval and/or improve risk stratification to better identify the small subset of patients most likely to have disease progression.