Chest X-Ray Favored for Lung Surveillance After High-Grade Soft Tissue Sarcoma

By Will Boggs MD

September 03, 2019

NEW YORK (Reuters Health) - Chest x-ray may be better than chest CT for lung surveillance after resection of high-grade soft-tissue sarcoma, according to findings from the U.S. Sarcoma Collaborative (USSC).

The National Comprehensive Cancer Network (NCCN) recommends lung surveillance with either chest x-ray (CXR) or chest CT for the prompt detection of lung metastases following resection of high-grade soft tissue sarcomas, but it remains unclear which imaging modality should be preferred.

Dr. Kenneth Cardona from Winship Cancer Institute at Emory University, in Atlanta, and colleagues used USSC data from 909 patients with high-grade soft-tissue sarcoma who underwent curative-intent resection to evaluate the difference between CXR and CT lung surveillance in regards to overall survival and cost to the U.S. healthcare system.

Lung surveillance was performed with CXR in 20% of patients and with CT in 80% of patients.

During a median follow-up of 33 months, 432 patients (48%) experienced recurrences, with 54% of those recurrences in the lungs.

In the first two years of follow-up, CXR detected 91% of lung metastases and CT detected 85% of lung metastases (P=0.88), with similar intervention rates to treat lung metastases in the groups (P=0.77).

On multivariable Cox regression analysis, lung metastasis was an independent predictor of worse overall survival, whereas lung-surveillance modality had no effect on overall survival, the researchers report in the Journal of the American College of Surgeons, online August 1.

On log-rank analysis, five-year lung-specific recurrence-free survival and overall survival were significantly higher in the CXR group than in the CT group (93% vs. 62% and 71% vs. 60%, respectively). But five-year overall survival did not differ between the groups when only patients in whom no lung metastasis was detected were included in the analysis (74% vs. 73%, respectively).

Together, these findings suggest that patients undergoing surveillance with CXR were not subjected to false-negative imaging for clinically relevant lesions that otherwise would have resulted in decreased overall survival, the researchers note.

According to a cost analysis, a CXR-based protocol compared to CT would result in a savings of between $5.5 and $7.9 million to the U.S. healthcare system over a five-year surveillance period, based on the 2018 Medicare Physician Schedule, depending on whether a low- or high-frequency strategy is used.

"Considering a potential cost savings of $5-8 million per 5-year surveillance period, a CXR-based protocol may optimize resource utilization for lung surveillance in patients after resection of high-grade soft tissue sarcoma," the researchers conclude. "Prospective trials are needed."

Dr. Cardona did not respond to a request for comments.


J Am Coll Surg 2019.