CONTENTS:

1.9 Low-Dose Chest Computed Tomography (LDCT) of the Chest or CT screening for lung cancer.
1.9.1 The DANTE Trial
1.9.2 The NELSON Trial
1.9.3 The Danish Randomized Lung Cancer CT Screening Trial
1.9.4 The UK Lung Cancer Screening (UKLS) Trial and LUNG-SEARCH
1.9.5 The MEDLUNG Study

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1.9 Screening Using Low-Dose Computed Tomography (LDCT) of the Chest

 
Low-dose ct screening for lung cancer imaging is a study that uses a multi-detector CT scanner. During the test, a single maximal inspiratory breath-hold is done with a scanning time of less than 25 seconds. The radiation dose is less than a third of a standard-dose, diagnostic CT examination of the chest.

Interestingly, published studies have demonstrated that chest ct screening with low-dose CT scans can identify early-stage, asymptomatic lung cancer. Indeed, some large, observational studies have included the Early Lung Cancer Action Project (ELCAP), the International ELCAP and the Continuous Observation of Smoking (COSMOS) study.  However, results from randomized trials are more helpful in making decisions about screening and in developing screening guidelines.

In addition, there are now a number of lung cancer screening clinical trials that have provided evidence to support LDCT as a first-stage test in the screening process. These results have helped to develop guidelines for lung cancer screening in certain countries.

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1.9.1 The DANTE Trial

 
The DANTE trial, is a randomized trial in Italy that enrolled 2,472 male smokers aged between 60 to 74 years. The trial is designed to assess lung cancer mortality during a 10-year period. Furthermore, the Dante trial compares five years of annual screening using LDCT or annual clinical follow-up. In this trial, the control group received baseline screening with chest X-ray and sputum cytology.

Firstly, The DANTE trial, using ct screening for lung cancer, detected 2.2 % of cases in the LDCT group (71 % stage I) and 0.67 % of cases in the control group (50 % stage I). In the trial, 15 % of individuals had an abnormal LDCT, and 4 % underwent an invasive diagnostic procedure.  Finally and notably, in 19% (6 out of 32) of  patients that underwent a thorocotomy a benign pulmonary lesion was diagnosed.

Patient follow-up was done at an average of 33.7 months and showed that lung cancer was found in 4.7 % of patients who received LDCT screening and in 2.8 % of controls. In addition, more stage I lung cancers were found in the screened group (54 % versus 34 %), but the number of advanced lung cancer cases (and lung cancer mortality) were found to be the same for the screened and the control patients.

It is important to note that this trial has been criticized for being small in size with preliminary data. For any clinical trial data to be assessed, longer patient follow-up would be required to detect a mortality difference between screened and non-screened patient groups.   More information on the Dante trial.

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1.9.2 The NELSON Trial: CT Screening for Lung Cancer

 
The NELSON trial is a randomized lung cancer trial using low dose and screening for lung cancer in the Netherlands and Belgium. The Nelson tiral used low dose ct screening for lung cancer in comparison to no screening in  7,557 current or former smokers. The Nelson study aims to assess the effects of giving up smoking, quality of life, and to estimate the cost-effectiveness of screening. This trial is unique in including 5-year lung cancer survivors.  Indeed the 5-year lung cancer survivor group are at very high risk of developing a new lung cancer. In conclusion, so far, the NELSON trial is the only large-scale trial to compare LDCT-screening with no screening. More information on the Nelson Trial.

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1.9.3 The Danish Randomized Lung Cancer CT Screening Trial

 
A Danish  randomized trial, using CT screening, examined 4,104 smokers (with at least 20 pack years) and aged 50 to 70 years.  The Danish trial  collaborated with the Nelson trial and shared data.

The initial data from the Danish trial detected a prevalence of lung cancer of 0.83 % (17 cases in 2052 participants).  Nine of the 17 lung cancer cases were in the early-stage (stage I). In addition, the condition of 11 of the subjects were surgically resectable. Thirdly,  8 cases qualified for minimally invasive surgery.  Finally, after five  years of screening the results show  more stage I-IIB Non Small-Cell Lung Cancers (NSCLC) in the ct screening group. In addition, in advanced lung cancer (stage III to IV) no notable differences were apparent between the two groups.  Click HERE for more information on this study.

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1.9.4 The U.K. Lung Cancer Screening (UKLS) Trial and LUNG-SEARCH

 
In the U.K., the National Institute for Health Research (NIHR), part of the National Health Service (NHS) has been conducting the U.K. Lung Cancer Screening (UKLS) trial since April 2011. Indeed, the data from the trial is due for publication in 2015.

Also in the U.K., the Health Technology Assessment (HTA) program examines tests that may be useful in ct screening for lung cancer in the Lung-SEARCH study.  This trial is using spiral CT scans combined with fluorescence bronchoscopy to detect early-stage lung cancer in patients with chronic obstructive pulmonary disease (COPD).   For more information on these trials.

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1.9.5 The MEDLUNG Study

 
The MEDLUNG trial is aimed at identifying possible biomarkers for detection of very early stages of lung cancer in people who are at high-risk.

Participants in the MEDLUNG study are having tests on samples of sputum, blood and lung tissue to detect changes in the lung cells. Furthermore, the aim of the above tests is to find a biomarker that can detect at risk people to screen for lung cancer in the future. For more information on theMedlung Study.

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References:

Horweg N, Scholten ET, Jong PA et al. (2014). Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet 15, 1342-1350. (Retrieved 23rd Jan 2015): http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70387-0/abstract

Van den Bergh KA, Essink-Bot ML, Bunge EM, et al. (2008). Impact of computed tomography screening for lung cancer on participants in a randomized controlled trial (NELSON trial). Cancer. 113(2), 396–404. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/18484588
 

More references for this section are on this page.

Patient Information:

Centers for Disease Control and Prevention (CDC) Lung Cancer: Information on Lung Cancer Screening. (Retrieved 22^nd Jan 2015): http://www.cdc.gov/cancer/lung/basic_info/screening.htm

CMS Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (Retrieved 22^nd Jan 2015): https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274
 

More patient information for this section is on this page
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