BACKGROUND: Despite the high survival rates reported for screening-detected cases, the potential of screening of high-risk subjects for reducing lung cancer mortality is still unproven. We herewith present the baseline results of a randomized trial comparing screening for lung cancer with annual spiral computed tomography (CT) versus a yearly clinical review. METHODS:Male subjects, 60-74 years old, and smokers of 20+ pack-years were enrolled. All participants received a baseline medical examination, chest X-rays (CXR) and sputum cytology upon accrual. Subjects randomized in the spiral CT group received a spiral CT scan at baseline, then yearly for the following 4 years. For controls, a yearly clinical examination was scheduled for the following 4 years. RESULTS:2472 subjects were randomized (1276 spiral CT arm, 1196 controls). Age, smoking exposure and co-morbid conditions were similar in the two groups. In the spiral CT group, 28 lung cancers were detected, 13 of which were visible in the baseline chest X-rays (overall prevalence 2.2%). Sixteen out of 28 tumours (57%) were stage I, and 19 (68%) were resectable. In the control group, eight cases were detected by the baseline chest X-rays (prevalence rate 0.67%), four (50%) were stage I, and six (75%) were resectable. CONCLUSIONS:Baseline lung cancer detection rate in the spiral CT arm was higher than in most published studies. The stage I detection rate was increased four-fold by spiral CT versus chest X-rays. However, more tumours in an advanced stage were also detected by CT. The high resection rate of screening-detected patients suggests a possible increase in cure rate. However, longer follow-up is required for definitive conclusions. This trial has been registered at www.Clinicaltrials.gov, registration No. NCT00420862.
RCT Entities:
BACKGROUND: Despite the high survival rates reported for screening-detected cases, the potential of screening of high-risk subjects for reducing lung cancer mortality is still unproven. We herewith present the baseline results of a randomized trial comparing screening for lung cancer with annual spiral computed tomography (CT) versus a yearly clinical review. METHODS: Male subjects, 60-74 years old, and smokers of 20+ pack-years were enrolled. All participants received a baseline medical examination, chest X-rays (CXR) and sputum cytology upon accrual. Subjects randomized in the spiral CT group received a spiral CT scan at baseline, then yearly for the following 4 years. For controls, a yearly clinical examination was scheduled for the following 4 years. RESULTS: 2472 subjects were randomized (1276 spiral CT arm, 1196 controls). Age, smoking exposure and co-morbid conditions were similar in the two groups. In the spiral CT group, 28 lung cancers were detected, 13 of which were visible in the baseline chest X-rays (overall prevalence 2.2%). Sixteen out of 28 tumours (57%) were stage I, and 19 (68%) were resectable. In the control group, eight cases were detected by the baseline chest X-rays (prevalence rate 0.67%), four (50%) were stage I, and six (75%) were resectable. CONCLUSIONS: Baseline lung cancer detection rate in the spiral CT arm was higher than in most published studies. The stage I detection rate was increased four-fold by spiral CT versus chest X-rays. However, more tumours in an advanced stage were also detected by CT. The high resection rate of screening-detected patients suggests a possible increase in cure rate. However, longer follow-up is required for definitive conclusions. This trial has been registered at www.Clinicaltrials.gov, registration No. NCT00420862.
Authors: Denise R Aberle; Christine D Berg; William C Black; Timothy R Church; Richard M Fagerstrom; Barbara Galen; Ilana F Gareen; Constantine Gatsonis; Jonathan Goldin; John K Gohagan; Bruce Hillman; Carl Jaffe; Barnett S Kramer; David Lynch; Pamela M Marcus; Mitchell Schnall; Daniel C Sullivan; Dorothy Sullivan; Carl J Zylak Journal: Radiology Date: 2010-11-02 Impact factor: 11.105
Authors: Marjolein A Heuvelmans; Matthijs Oudkerk; Geertruida H de Bock; Harry J de Koning; Xueqian Xie; Peter M A van Ooijen; Marcel J W Greuter; Pim A de Jong; Harry J M Groen; Rozemarijn Vliegenthart Journal: Eur Radiol Date: 2013-03-19 Impact factor: 5.315
Authors: Rachel M Ostroff; William L Bigbee; Wilbur Franklin; Larry Gold; Mike Mehan; York E Miller; Harvey I Pass; William N Rom; Jill M Siegfried; Alex Stewart; Jeffrey J Walker; Joel L Weissfeld; Stephen Williams; Dom Zichi; Edward N Brody Journal: PLoS One Date: 2010-12-07 Impact factor: 3.240