CT-Based Versus Minimal Follow-up for Patients With Resected NSCLC: Difference in Survival?

By: Justine Landin, PhD
Posted: Tuesday, January 3, 2023

Following complete resection, CT-based follow-up procedures may increase the likelihood of pathologic detection of early recurrence and second primary tumor for patients with non–small cell lung cancer (NSCLC), according to a phase I/II study conducted by Virginie Westeel, MD, of the University of Franche-Comté, Besançon, France, and colleagues. However, the addition of CT-based procedures during follow-up did not appear to improve survival compared with clinic visits and x-rays alone. The findings of this open-label, randomized, multicenter phase III trial (IFCT-0302) were published in The Lancet Oncology.

“The results of this large, randomized study provide guidance for clinicians and decision makers regarding the follow-up of patients who have undergone surgery for lung cancer,” stated the study investigators.

Patients with pathologic stage I to IIIa NSCLC who had undergone complete resection within the past 8 weeks were enrolled from 122 centers in France (n = 1,775). Patients were randomly assigned to receive either minimal (n = 888) or CT-based (n = 887) follow-up. CT-based follow-up included clinic visits, x-rays, CT scans, and fiberoptic bronchoscopy, whereas minimal follow-up included clinic visits and x-rays alone.

The median overall survival did not differ significantly based upon follow-up procedures, according to the study authors (8.5 years for the minimal follow-up group and 10.3 years for the CT-based follow-up group; P = .49). Median disease-free survival also did not significantly differ between groups. However, the CT-based follow-up group appeared to have a higher recurrence detection rate (32.6%) compared with the minimal follow-up group (27.7%). Similarly, detection of second primary lung cancer was found to be slightly higher in the CT-based follow-up group (4.5%) compared with the minimal follow-up group (3.0%).

“Routine follow-up should be part of a comprehensive surveillance program in patients with resected NSCLC, which should also include patient education, organized prompt management of patients who are symptomatic, smoking cessation measures, and treatment for comorbidities,” the study authors concluded.

Disclosure: For full disclosures of the study authors, visit thelancet.com.

The Lancet Oncology