Timing of CT Screening Questioned For Complete NSCLC Resection Patients

Computed tomography follow-up after complete non-small-cell lung cancer resection may be best targeted to patients who achieve 2 years disease-free survival

medwireNews: IFCT-0302 findings indicate that regular computed tomography (CT) imaging does not improve the overall survival (OS) of patients who have undergone complete resection of non-small-cell lung cancer (NSCLC).

Delegates at the ESMO 2017 Congress in Madrid, Spain, were told that the phase III study is the first randomised trial designed to test the benefit of systematic follow-up and CT screening in lung cancer patients, as recommended by several clinical guidelines.

The trial recruited 1775 patients within 8 weeks of undergoing successful resection of pathological stage I, II, IIIA or T4, N0–2 NSCLC, said presenting author Virginie Westeel, from Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz in Besançon, France.

Median OS was 123.6 months for the patients who were randomly assigned to receive a clinical examination, chest X-ray and chest CT imaging, plus bronchoscopy where applicable, every 6 months for 2 years, followed by annual examination at 3, 4 and 5 years.

This was not significantly longer than the median OS of 99.7 months achieved by patients who were followed-up only with clinical examination and chest X-ray.

The two patients groups also had comparable OS rates at 3 years (76.1 vs 77.3%), 5 years (65.8 vs 66.7%) and 8 years (54.6 vs 51.7%), reported Virginie Westeel.

“Because there is no difference between arms, both follow-up protocols are acceptable”, she commented in a press release.

Exploratory analysis showed that additional CT imaging did not improve the OS of the subgroup of patients who had experienced disease progression within 2 years of follow-up, at a median of 48.3 months versus 48.4 months.

By contrast, CT screening appeared to significantly benefit patients who were free from progression at 2 years. Median OS was unreached for the patients who had received CT screening whereas patients who received only clinical examination and chest X-ray had a median OS of 129.3 months.

“A conservative point of view would be to do a yearly CT-scan, which might be of interest over the long-term”, Virginie Westeel commented in a press release, acknowledging the potential benefit of CT screening to NSCLC survivors who have a high risk of developing further primary lung tumours.

“[H]owever, doing regular scans every six months may be of no value in the first two post-operative years,” she concluded.

Reference

Westeel V, Barlesi F, Foucher P, et al. 1273O - Results of the phase III IFCT-0302 trial assessing minimal versus CT-scan-based follow-up for completely resected non-small cell lung cancer (NSCLC). ESMO 2017 Congress; Madrid, Spain, 8–11 September

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