Adding CT to X-Ray for Follow-up of Completely Resected NSCLC

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In a French phase III trial (IFCT-0302) reported in The Lancet Oncology, Westeel et al found that a strategy including computed tomography (CT) and x-ray vs x-ray alone did not improve overall survival when used in the follow-up of patients with completely resected non–small cell lung cancer (NSCLC).

Study Details

In the multicenter open-label trial, 1,775 patients who underwent complete resection for stage I to III disease were randomly assigned between January 2005 and November 2012 to follow-up, including clinic visits, chest x-rays, chest CT scans, and fiberoptic bronchoscopy (CT-based follow-up group; n = 887) or clinical visits and chest x-rays (minimal follow-up group; n = 888). Procedures were repeated every 6 months for the first 2 years and yearly until 5 years. The primary endpoint was overall survival in the intention-to-treat population.

Key Findings

Median overall survival was 10.3 years (95% confidence interval [CI] = 8.1 years to not reached) in the CT-based follow-up group vs 8.5 years (95% CI = 7.4–9.6 years) in the minimal follow-up group (adjusted hazard ratio [HR] = 0.95, 95% CI = 0.83–1.10, P = .49). Overall survival rates at 3 and 5 years were 76.1% vs 77.2% and 65.8% vs 66.8%, respectively. Median disease-free survival was 4.9 years (95% CI = 4.3 years to not reached) in the CT-based follow-up group vs not reached (95% CI = not estimable to not estimable) in the minimal follow-up group (adjusted HR = 1.14, 95% CI = 0.99–1.30, P = .063).

Disease recurrence was detected in 289 patients (32.6%) in the CT-based follow-up group (symptomatic in 162 [62.0%]) vs 246 patients (27.7%) in the minimal follow-up group (symptomatic in 203 [82.5%]). Second primary lung cancers were diagnosed in 40 patients (4.5%; asymptomatic in 33 [82.5%]) vs 27 patients (3.0%; asymptomatic in 13 [48.1%]).  

No serious adverse events related to the study procedures were reported.

The investigators concluded: “The addition of thoracic CT scans during follow-up, which included clinic visits and chest x-rays after surgery, did not result in longer survival among patients with NSCLC. However, it did enable the detection of more cases of early recurrence and second primary lung cancer, which are more amenable to curative-intent treatment, supporting the use of CT-based follow-up, especially in countries where lung cancer screening is already implemented, alongside with other supportive measures.”

Virginie Westeel, MD, of the Chest Disease and Thoracic Oncology Department, University Hospital of Besançon, is the corresponding author of The Lancet Oncology article.

Disclosure: The study was funded by the French Health Ministry, French National Cancer Institute, Weisbrem-Benenson Foundation, La Ligue Nationale Contre Le Cancer, and Lilly Oncology. For full disclosures of the study authors, visit

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