Comparing Two Imaging Methods for Follow-Up of Lung Cancer Treatment: A Randomized Pilot Study

Gambazzi, Franco; Frey, L.; Bruehlmeier, Matthias; Janthur, Wolf-Dieter; Graber, Sereina M; Heuberger, J.; Springer, O; Zweifel, Roland; Boerner, Bettina; Tini, Gabrielo M.; Irani, Sarosh

doi:10.1016/j.athoracsur.2018.08.015

Cited by 16 publications

(12 citation statements)

References 15 publications

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“…32 There were no suitable surveillance studies available for analysis reliant on PROMs or biomarkers. Intended duration of follow-up was 2 years, 33,34 5 years, [35][36][37] ongoing, 38 or undefined. Primary curative-intent treatment in the 13 studies included surgical resection (lobectomy, bilobectomy, or pneumonectomy), neoadjuvant chemotherapy followed by resection, resection with chemotherapy or radiotherapy, SBRT, and chemoradiotherapy.…”

Section: Resultsmentioning

confidence: 99%

“…Report of diagnostic accuracy was available from four studies. Sensitivity for detection of recurrent disease by CXR was 21.2%, 36 by CT 93% to 94.2%, 33,36 and by PET-CT 80.8% to 94.4% 33,37,39 (Fig. 4).…”

Section: Diagnostic Accuracymentioning

confidence: 94%

“…Nine studies were available in which the proportions of disease recurrence or SPLC were detected by scheduled versus unscheduled radiological followup. [33][34][35][36][39][40][41][42][43] The pooled estimate for odds of detection by scheduled follow-up provided an OR equal to 8.15 (95% CI: 3.5-18.9, p < 00001), although the estimate was associated with substantial trial heterogeneity, chisquare p value equal to 0.00001, and I 2 equal to 94% (Fig. 3A).…”

Section: Disease Recurrence and Splcmentioning

confidence: 99%

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Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

Stirling

Chau

Shareh

et al. 2021

Journal of Thoracic Oncology

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Introduction: Patients with NSCLC may be treated with curative intent, yet they remain at high risk of both disease recurrence and second primary lung cancer (SPLC) and increased risk of early death. Guidelines provide recommendations for follow-up, but there is little consensus, and review of available evidence is necessary. The use of a systematic follow-up strategy for the detection of disease recurrence or SPLC after curative-intent treatment of NSCLC may increase the proportion of patients available for retreatment and increase the survival of patients with surveillance detection. Methods:We performed a systematic review and metaanalysis of prospective studies on follow-up of NSCLC after curative-intent treatment to answer the following three questions: What is the effect of follow-up on detection of recurrence or SPLC? What is the effect of surveillance detection on curative-intent retreatment? What is the survival impact?Results: Recurrence or SPLC was observed in 17.8% to 71% of patients. Scheduled imaging-detected recurrence in 60% to 100% of cases, yet neither computed tomographybased (OR ¼ 2.31, 95% confidence interval [CI]: 0.27-19.49, p ¼ 0.44) nor positron emission tomographycomputed tomography-based follow-up (OR ¼ 1.431, 95% CI: 0.92-2.22, p ¼ 0.12) was statistically superior to standard follow-up strategies. Detection of disease recurrence/SPLC significantly increased the odds of curativeintent retreatment (OR ¼ 4.31; 95% CI: 2.10-8.84, p < 0.0001). Curative-intent retreatment prolonged survival in reported studies. Conclusions:The early detection of disease recurrence/ SPLC may increase the likelihood of curative-intent retreatment and prolong survival. There is a clear need for prospective randomized controlled studies of follow-up to confirm effectiveness of available follow-up modalities.

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Section: Resultsmentioning

confidence: 99%

Section: Diagnostic Accuracymentioning

confidence: 94%

Section: Disease Recurrence and Splcmentioning

confidence: 99%

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Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

Stirling

Chau

Shareh

et al. 2021

Journal of Thoracic Oncology

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“…The study did not find PET/ceCT to be better than ceCT in detection of recurrence, however, thus emphasizing that the sample size was too small to detect minor differences or to discriminate between treatment modality and stage. 11 Despite the scarcity of evidence, the use of PET/ceCT for follow-up has been increasing, but better evidence for the role of PET/ceCT is needed. 12 Blood carries various potential cancer biomarkers, such as circulating tumor cells, microRNA, and ctDNA.…”

Section: Discussionmentioning

confidence: 99%

Surveillance With PET/CT and Liquid Biopsies of Stage I-III Lung Cancer Patients After Completion of Definitive Therapy: A Randomized Controlled Trial (SUPER)

Skougaard

Guldbrandsen

Sørensen

et al. 2020

Clinical Lung Cancer

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Despite increased focus on prevention as well as improved treatment possibilities, lung cancer remains among the most frequent and deadliest cancer diagnoses worldwide. Even lung cancer patients treated with curative intent have a high risk of relapse, leading to a dismal prognosis. More knowledge on the efficacy of surveillance with both current and new technologies as well as on the impact on patient treatment, quality of life, and survival are urgently needed. We therefore designed a randomized phase 3 trial. In one arm, every other computed tomography (CT) scan is replaced by positron emission tomography/CT, the other arm is the standard follow-up scheme with CT. The standard arm is identical to the current national Danish follow-up program. The primary endpoint is to compare the number of relapses treatable with curative intent in the 2 arms. We aim to include 750 patients over a 3-year period. Additionally, we will test the feasibility of noninvasive lung cancer diagnostics and surveillance in the form of circulating tumor DNA analysis. For this purpose, blood samples are collected before treatment and at each following control. The blood samples are stored in a biobank for later analysis and will not be used for guiding patient treatment decisions.

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“…This study was a post hoc analysis of a randomized pilot study that has recently been published [15]. The study protocol of this prospective study was approved by our Ethics Committee (Kantonale Ethikkommission Aargau, Switzerland, Protocol No 2011/045).…”

Section: Methodsmentioning

confidence: 99%

Image analysis in posttreatment non-small cell lung cancer surveillance: specialists’ interpretations reviewed by the thoracic multidisciplinary tumor board

Gambazzi

Frey

Bruehlmeier

et al. 2019

Multidiscip Respir Med

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BackgroundData show that the initial specialist’s image interpretation and final multidisciplinary tumor board (MTB) assessment can vary substantially in the pretherapeutic cancer setting. The aim of this post hoc analysis was to investigate the concordance of the specialist’s and MTB’s image interpretations in patients undergoing systematic posttreatment lung cancer image surveillance.MethodsIn the initial prospective study, lung cancer patients who had received curative-intent treatment were randomly assigned to undergo either contrast-enhanced computed tomography (CE-CT) or integrated 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Imaging was performed every 6 months for 2 years, and all imaging studies were finally assessed by our MTB. This post hoc analysis assessed differences between the initial specialist’s image interpretation and the final MTB’s image interpretation.ResultsIn 89 patients, 266 imaging studies (129 PET-CT, 137 CE-CT) were analyzed. In 87.2% (88.4, 86.1%) of the studies, complete concordance was found. Out of the 12.8% (11.6, 13.9%) with discordant results, 7.5% (6.9, 8.0%) had implications for alterations in patient management (major disagreements).Twenty major disagreements were detected in 17 study patients. Retrospectively, in eight out of these 17 (47%) patients, in contrast to the MTB’s view, the specialist’s interpretation was more appropriate, whereas in nine out of 17 patients (53%), the MTB’s interpretation was more accurate.ConclusionsIn an experienced MTB, the agreement between imaging specialists and the rest of the MTB with regard to the interpretation of images is high in a setting of posttreatment lung cancer image surveillance. It seems that in cases of disagreements, the rates of more accurate interpretation are well balanced between imaging specialists and the MTB.Trial registrationISRCTN16281786, Date 23. February 2017.

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Comparing Two Imaging Methods for Follow-Up of Lung Cancer Treatment: A Randomized Pilot Study

Cited by 16 publications

References 15 publications

Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

Effect of Follow-Up Surveillance After Curative-Intent Treatment of NSCLC on Detection of New and Recurrent Disease, Retreatment, and Survival: A Systematic Review and Meta-Analysis

Surveillance With PET/CT and Liquid Biopsies of Stage I-III Lung Cancer Patients After Completion of Definitive Therapy: A Randomized Controlled Trial (SUPER)

Image analysis in posttreatment non-small cell lung cancer surveillance: specialists’ interpretations reviewed by the thoracic multidisciplinary tumor board

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