Regular CT scans as a part of follow-up for patients with completely resected non-small cell lung cancer (NSCLC), recommended by many guidelines, may be unnecessary, noted researchers of the IFCT-0302 trial. They found that such follow-up made no difference in overall survival (OS), and presented their results at the European Society for Medical Oncology (ESMO) 2017 Congress in Madrid, Spain.
They observed no difference in OS between patients who received CT as part of their follow-up and those who did not.
“Because there is no difference between arms, both follow-up protocols are acceptable,” said study investigator Prof. Virginie Westeel, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz in Besançon, France. “A conservative point of view would be to do a yearly CT-scan, which might be of interest over the long-term, however, doing regular scans every 6 months may be of no value in the first 2 post-operative years,” she said.
These results go against standard clinical practice and the majority of medical societies and clinical practice guidelines that recommend follow-up visits in which chest CT is considered appropriate every 3 to 6 months in the first 2 years after surgery in these patients.
In the multicenter IFCT-0302 trial, Dr. Westeel and colleagues included 1,775 patients with completely resected stage I-II-IIIA NSCLC who completed follow-up visits every 6 months for the first 2 years, and then annually until 5 years. They randomized patients to a control follow-up group, who underwent clinical exam and chest X-ray (CXR), or an experimental follow-up group to have the control protocol with the addition of thoraco-abdominal CT plus bronchoscopy (optional for adenocarcinomas).
OS did not differ significantly between the groups after a median follow-up of 8 years and 10 months (HR: 0.95; 95% CI: 0.82, 1.09; P=0.37), with a median of 99.7 months in the control arm, and 123.6 months in the experimental arm.
Dr. Westeel and fellow researchers also observed similar 3-year, disease-free survival rates (63.3% and 60.2%, respectively) and similar 8-year OS rates (51.7% and 54.6%).
Commenting on the study, ESMO spokesperson Dr. Floriana Morgillo, University of Campania Luigi Vanvitelli, Naples, Italy, said: “A significant proportion of patients with early stage NSCLC develop second cancers between the second and fourth year after surgery, and early detection of these with CT-based surveillance beyond 2 years could allow curative treatment.”
She added that although the study does not demonstrate a significant benefit with CT-based follow-up, the trend towards better survival in the CT arm suggests longer follow-up may eventually reveal a benefit of this approach. In the meantime, however, CT-based surveillance is still an appropriate option because of its potential for impacting second primary cancers, she concluded.