CT Surveillance After NSCLC Resection Does Not Improve Survival

A study comparing two options for follow-up protocol after complete resection of non–small-cell lung cancer (NSCLC) found no significant difference between the two protocols. The result suggests that regular CT scans after resection may not be necessary, though there may still be some benefits to these additional scans.

“A conservative point of view would be to do a yearly CT scan, which might be of interest over the long term,” said the study’s lead investigator Virginie Westeel, MD, PhD, of Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz in Besançon, France. “However, doing regular scans every 6 months may be of no value in the first 2 postoperative years.” She presented the study’s results at the European Society for Medical Oncology (ESMO) 2017 Congress, held September 8–11 in Madrid (abstract 1273O).

Several guidelines include those regular CT scans in follow-up protocols, but the previous evidence was limited. The new IFCT-0302 trial randomized 1,775 NSCLC patients who underwent complete resection to one of two arms: arm 1’s protocol consisted of clinical examination and chest X-ray; arm 2 involved the same along with thoraco-abdominal CT scan plus bronchoscopy (optional for adenocarcinomas). Both were repeated every 6 months after randomization for the first 2 years, and then yearly until 5 years.

After a median follow-up of 8 years and 10 months, the overall survival was no different between the groups. The hazard ratio for survival was 0.95 (95% CI, 0.82–1.09; P = .37). The median overall survival was 99.7 months in arm 1, considered the control patients, and 123.6 months in the experimental arm.

At 3 years, the disease-free survival rates were similar, at 63.3% in the control patients and 60.2% in the experimental patients. This remained true out to the 8-year overall survival rates, at 51.7% and 54.6%, respectively.

“Because there is no difference between arms, both follow-up protocols are acceptable,” Westeel concluded.

Floriana Morgillo, MD, PhD, of the University of Campania Luigi Vanvitelli in Naples, Italy, commented on the study, and pointed out that the trend toward better survival with the addition of the CT scans suggests that longer follow-up may still be needed to tease out the true differences.

Furthermore, the CT scan’s ability to detect second malignancies means that it may still be the better option. “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 said.