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Best Practices in lung cancer – November 2017 Vol 8

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Non–Small Cell Lung Cancer

Regular CT Scans During Follow-Up May Not Be Necessary

Findings of a randomized study suggest that follow-up CT scans may not be needed every 3 to 6 months during the first 2 years after surgery for patients with non–small cell lung cancer (NSCLC). The IFCT-0302 trial, presented at the ESMO 2017 Congress, showed no statistically significant difference in overall survival (OS) between patients who received CT scans as part of their follow-up versus those who did not.

The guidelines from most clinical societies call for regular CT scans every 3 to 6 months in the first 2 years after surgery. These findings call current guidelines into question, but experts who spoke at ESMO said that survival was numerically superior in the regular CT scan arm, and CT scans detect second cancers. Even though it could reduce the costs of healthcare, most experts said they would continue to follow the guidelines.

“Because there is no difference between arms, both follow-up protocols are acceptable,” said study investigator Virginie Westeel, MD, from 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 postoperative years,” she said.

The multicenter IFCT-0302 trial included 1775 patients with completely resected stage I, II, or IIIA NSCLC who completed follow-up visits every 6 months for the first 2 years, and yearly to 5 years.

Patients were randomized to a control follow-up that included clinical examination and chest x-ray or an experimental follow-up that included the control protocol with the addition of thoraco-abdominal CT scan plus bronchoscopy (optional for adenocarcinomas).

After a median follow-up of 8 years 10 months, OS was not significantly different between the groups (hazard ratio, 0.95; 95% CI, 0.82-1.09; P = .37) at a median of 99.7 months in the control arm and 123.6 months in the experimental arm.

Three-year disease-free survival rates were also similar at 63.3% and 60.2%, respectively, as were 8-year OS rates at 51.7% and 54.6%, respectively.

ESMO Perspective

Commenting on the study, ESMO spokesperson Floriana Morgillo, MD, University of Campania Luigi Vanvitelli, Naples, Italy, said that although the study does not demonstrate a significant benefit with CT-based follow-up, the trend toward better survival in the CT arm suggests longer follow-up may eventually reveal a benefit of this approach.

However, in the meantime, she stated that CT-based surveillance is still an appropriate option because of its potential for impacting second primary cancers.

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