Regular CT Scans for NSCLC Follow-Up May Not Be Necessary

Phoebe Starr

November 2017, Vol 7, No 11 - ESMO Highlights, Lung Cancer


Madrid, Spain—Findings from a randomized clinical trial suggest that follow-up computed tomography (CT) scans in patients with fully resected non–small-cell lung cancer (NSCLC) may not be needed every 3 to 6 months in the first 2 years after surgery. Results of the IFCT-0302 study were presented at the 2017 European Society for Medical Oncology (ESMO) Congress, showing no significant difference in overall survival (OS) among patients who had CT scans as part of their follow-up versus those who did not.

Most clinical societies’ guidelines call for regular CT scans every 3 to 6 months in the first 2 years after NSCLC surgery. These new findings call current guidelines into question, but experts who spoke at ESMO said that survival was numerically (although not statistically) superior in the regular CT scan arm, and CT scans detected second cancers. Even though it could reduce the costs of healthcare, many experts said that they would continue to follow current guidelines that call for regular scans.

“Because there is no difference between arms, both follow-up protocols are acceptable,” said study investigator Virginie Westeel, MD, PhD, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France, who presented the results. “A conservative point of view would be to do a yearly CT scan; however, doing regular scans every 6 months may be of no value in the first 2 postoperative years.”

The IFCT-0302 study included 1775 patients with completely resected early-stage (stage I-II/IIIA) NSCLC who had follow-up visits every 6 months for 2 years, and then annually for 3 years.

The patients were randomized to clinical examination and chest x-ray or to clinical examination, chest x-ray, and a CT scan plus bronchoscopy.

After a median follow-up of 8 years and 10 months, the OS was a median of 99.7 months in the first arm and 123.6 months in the arm with CT scan (hazard ratio, 0.95; 95% confidence interval, 0.82-1.09; P = .37). Similarly, the 3-year disease-free survival was 63.3% and 60.2%, respectively, and the 8-year OS rates were 51.7% and 54.6%, respectively, all demonstrating a nonsignificant difference.

Expert Perspectives

ESMO spokesperson Enriqueta Felip, MD, PhD, Head of the Lung Cancer Unit, Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain, commented on this study. “I think this is a relevant study. For patients in the study, survival is good. Regular scans have a potential long-term benefit, especially in detecting second cancers. In my clinical practice, I will continue to do CT scans. I will not change my practice. Even though this is an important trial, tomorrow I will follow my patients with a CT scan.”

Also commenting on the study, ESMO spokesperson Floriana Morgillo, MD, PhD, University of Campania Luigi Vanvitelli, Naples, Italy, agreed that although no significant benefit has been shown in the CT scan arm, a trend was seen toward improved survival with the CT scan follow-up, which suggests that longer follow-up duration may yet show benefit.

Dr Morgillo added that surveillance with regular CT scans is an appropriate option, because it detects second primary lung cancer.