Combination of CT and X-ray chest detects early recurrence and second primary Lung cancer: LANCET

A combination of thoracic CT scan with chest x-ray during follow-up helps in detecting early recurrence and second primary lung cancer as per a recent trial that was published in the journal, 'The Lancet Oncology.' 

There is an increased risk of developing recurrence and second primary lung cancer even after resection of early-stage non-small-cell lung cancer (NSCLC). Hence, researchers conducted a trial to estimate the efficacy of clinic visits, chest x-rays, chest CT scans, and fiber-optic bronchoscopy versus clinical visits and chest x-rays after surgery for resectable NSCLC during the follow-up visits. 

A multicentre, open-label, randomized, phase 3 trial (IFCT-0302) was conducted in 122 hospitals and tertiary centers in France. Patients aged 18 years or older and with completely resected pathological stage I–IIIA NSCLC as per TNM classification were enrolled within 8 weeks of resection. Patients were randomly assigned (1:1) to CT-based follow-up and minimal follow-up by a computer-generated sequence using the minimization method. CT-based follow-up had clinic visits, chest x-rays, thoracoabdominal CT scans, and fiber-optic bronchoscopy for non-adenocarcinoma histology and minimal follow-up had visits and chest x-rays. All these were repeated every 6 months for 2 years and yearly for 5 years. The overall survival rate in the intention-to-treat population was the primary endpoint and disease-free survival was the secondary endpoint.  

Results: 

• 1775 patients were enrolled and randomly assigned to a follow-up group which had 888 patients in the minimal follow-up group and 887 patients in the CT-based follow-up group between Jan 3, 2005, and Nov 30, 2012.
• Median overall survival was not significantly different between follow-up groups with 8·5 years in the minimal follow-up group vs 10·3 years in the CT-based follow-up group. 
• Disease-free survival was not significantly different between follow-up groups.
• Recurrence was detected in 246 (27·7%) of 888 patients in the minimal follow-up group and 289 (32·6%) patients of 887 in the CT-based follow-up group.
• Second primary lung cancer was diagnosed in 27 (3·0%) patients in the minimal follow-up group and 40 patients (4·5%) in the CT-based follow-up group.
• No serious adverse events related to the trial procedures were reported.

Thus, it was found from the trial that even though the addition of thoracic CT scans along with clinic visits and chest x-rays after surgery during follow-up did not result in longer survival among patients with NSCLC, it enabled to detect of early recurrence and second primary lung cancer which help in the curative-intent treatment. 

For the full article, click here: https://doi.org/10.1016/S1470-2045(22)00451-X

Westeel V, Foucher P, Scherpereel A, et al. Chest CT scan plus x-ray versus chest x-ray for the follow-up of completely resected non-small-cell lung cancer (IFCT-0302): a multicentre, open-label, randomised, phase 3 trial [published online ahead of print, 2022 Aug 11]. Lancet Oncol. 2022;S1470-2045(22)00451-X.