IFCT-0302: Importance of CT scans for post-surgery follow-up in NSCLC patients is questioned

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.

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Follow-up for resected NSCLC

Regular CT scans made no difference in overall survival.

Follow-up for resected NSCLC

Regular CT scans made no difference in overall survival.

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.