Forget about it.
Top Line: Does intensive follow up for resected NSCLC improve survival?
The Study: We’ve recently seen quite a few large trials evaluating the intensity of follow up after primary cancer treatment. IFCT-0302 was a French multicenter phase 3 trial that randomized patients with completely resected stage I-IIIA NSCLC to surveillance imaging with chest x-ray and abdominopelvic CT (plus bronchoscopy for non-adenocarcinomas) or chest x-ray alone. Imaging was done every 6 months for 2 years and then annually out to 5 years. The trial enrolled 1775 patients. Even though neoadjuvant chemotherapy in a similar population improves survival by 5%, IFCT-0302 was designed to detect a whopping 7.5% improvement in overall survival just by changing the intensity of follow up. As you might expect, this statistical design found no difference in median overall survival with more intensive imaging (10.3 v 8.5 years). However, more recurrences were detected with more intensive imaging (32.6% v 27.7%) as were second primary lung cancers (4.5% v 3%). It is questionable how relevant this study is to practice in the U.S. given that our routine surveillance imaging is even more intensive than the intensive arm of this trial. Nevertheless, it provides perspective on the role of surveillance in impacting survival for early stage NSCLC.
TBL: “Intensive” surveillance after resection of NSCLC does not dramatically increase overall survival. | Westeel, Lancet Oncol 2022