FREQUENT CTs DURING FOLLOW UP DOES NOT INCREASE SURVIVAL OF NSCLC PATIENTS

Performing computed tomography (CT) surveillance in lung cancer survivors more than once a year is not associated with improved survival, according to new research.

"Our study, including 4,463 patients surveilled with CT, and with five-year follow-up on all patients, demonstrates that more frequent surveillance was not associated with improved survival or postrecurrence survival," Dr. Benjamin D. Kozower of Washington University School of Medicine in St. Louis and colleagues write in their July 12 report in Annals of Surgery.

Recommendations for follow-up after non-small cell lung cancer (NSCLC) are variable, Dr. Kozower and his colleagues note. "Importantly, the National Comprehensive Cancer Network describes their recommendation as category 2A, indicating there is consensus that the intervention is appropriate but based on lower-level evidence," they add.

The authors looked at surveillance frequency and survival in 4,463 stage I-III NSCLC patients diagnosed in 2006-2007 and treated with surgical resection. An additional 5,150 patients had not been followed with CT, and were not included in the analysis.

Thirty-six percent of the study participants underwent surveillance every three months, 45% every six months, and 19% annually. Among patients who were alive and free of cancer 14 months after surgery, 11% developed a new primary cancer during follow-up and 23.8% had a recurrence.

The authors found no association between the intensity of surveillance and survival.

"One of the take-home lessons from this article is that there is a good reason to have guidelines and to follow them, and NCCN in particular has provided a thoughtful recommendation that I think actually fits with the outcomes of this paper," Dr. Douglas E. Wood, The Henry N. Harkins Professor and Chair of the Department of Surgery at the University of Washington in Seattle, told Reuters Health in a telephone interview. Dr. Wood is vice-chair of the NCCN's NSCLC guidelines panel.

The NCCN recommends CT scans every six to 12 months for the first two years after surgery for NSCLC. One "shocking" aspect of the study that the authors don't emphasize, Dr. Wood said, is that more than half of the patients in the National Cancer Database sample received no surveillance with CT at all. These patients were likely followed with chest X-rays, which are not sensitive or specific enough to be used for lung cancer surveillance, he said.

From 2% to 4% of NSCLC survivors develop new lung cancers, Dr. Wood noted, so continued surveillance is important for identifying these cancers at an early, treatable stage. "We do have a big impact in detecting new lung cancers and affording those patients a new opportunity for curative-intent therapy," he said.

Dr. Kozower was not available for an interview by press time.