Respiratory Trials·org

Topic

Lung cancer

Screening, the solitary pulmonary nodule, and systemic therapy.

Screening works, and the argument is about how to deliver it. Low-dose CT reduced lung cancer mortality against chest radiography, with 24% of screens positive and 96% of those positives false (NLST). Volumetric nodule assessment against no screening produced the same mortality benefit with a referral rate of 2.1% (NELSON) — the difference between a programme that overwhelms services and one that runs.

Less surgery may be enough. For peripheral tumours 2 cm or smaller with intraoperatively confirmed node-negative disease, sublobar resection was non-inferior to lobectomy for disease-free survival at a median of seven years (CALGB 140503). Preserving lung tissue matters more as screening finds earlier cancers in patients who may face a second primary.

Lung cancer screening

Trial Year Therapy Effect Finding
NELSON 2020 Volume CT screening Volume CT screening reduced lung cancer mortality with a 2.1% referral rate
NLST 2011 Low-dose CT screening Low-dose CT screening reduced lung cancer mortality — at the cost of a 96% false-positive rate

Extent of resection

Trial Year Therapy Effect Finding
CALGB 140503 2023 Sublobar resection Sublobar resection matched lobectomy for small peripheral node-negative lung cancers

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