Expanding follow-up procedures to include CT scans may be beneficial for patients who have undergone resection of early-stage non-small cell lung cancer (NSCLC), according to results of a phase 3 study published in The Lancet Oncology.

A follow-up approach that included thoracic CT scans and fiber-optic bronchoscopy as well as chest x-rays and clinic visits proved more effective than x-rays and clinic visits alone for early detection of lung cancer recurrence and second primary lung cancers. 

However, the expanded follow-up procedures did not improve overall survival (OS) when compared with x-rays and clinic visits alone.

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This phase 3 trial (ClinicalTrials.gov Identifier: NCT00198341) included 1775 patients with stage I-IIIA NSCLC who underwent resection. The patients were randomly assigned to undergo a minimal follow-up approach (n=888) or a CT-based follow-up approach (n=887).

The CT-based approach included thoraco-abdominal CT imaging, clinic visits, chest x-rays, and fiber optic bronchoscopy for patients with nonadenocarcinoma histology. The minimal follow-up approach included only clinic visits and chest x-rays. 

At a median follow-up of 7.2 years, the CT-based follow-up approach failed to improve OS. The median OS was 10.3 years in the CT-based follow-up group and 8.5 years in the minimal follow-up group (hazard ratio [HR], 0.95; 95% CI, 0.83-1.10; P =.49). 

The 3-year OS rate was 76.1% in the CT group and 77.2% in the minimal group. The 5-year OS rates were 65.8% and 66.8%, respectively.

Similarly, disease-free survival (DFS) was not significantly different between the groups. The median DFS was 4.9 years in the CT-based group but was not reached in the minimal follow-up group (HR, 1.14; 95% CI, 0.99-1.30; P =.063).

However, recurrence was detected more frequently in the CT-based follow-up group than in the minimal follow-up group — 32.6% and 27.7%, respectively. Of the patients with recurrence, 56.0% in the CT group were symptomatic, compared with 82.5% in the minimal follow-up group. 

The CT-based approach also detected more second primary lung cancers than the minimal approach — 4.5% and 3.0%, respectively. In the CT-based follow-up group, 85.0% of second primary lung cancers were detected via CT scan. 

“On the basis of these results, both follow-up strategies might be considered for routine implementation, taking into account the balance between higher costs and supplementary and potentially invasive procedures resulting from more intensive follow-up with CT and the benefit of an earlier diagnosis of recurrence or second primary lung cancer,” the researchers wrote. 

Disclosures: This study was supported, in part, by Lilly Oncology. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


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. Lancet Oncol. Published online August 11, 2022. doi:10.1016/S1470-2045(22)00451-X