A randomized study of lung cancer screening with spiral computed tomography: Three-year results from the DANTE trial

Maurizio Infante, Silvio Cavuto, Fabio Romano Lutman, Giorgio Brambilla, Giuseppe Chiesa, Giovanni Ceresoli, Eliseo Passera, Enzo Angeli, Maurizio Chiarenza, Giuseppe Aranzulla, Umberto Cariboni, Valentina Errico, Francesco Inzirillo, Edoardo Bottoni, Emanuele Voulaz, Marco Alloisio, Anna Destro, Massimo Roncalli, Armando Santoro, Gianluigi Ravasi

Research output: Contribution to journalArticle

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Abstract

Rationale: Screening for lung cancer with modern imaging technology may decrease lung cancer mortality, but encouraging results have only been obtained in uncontrolled studies. Objectives: To explore the effect of screening with low-dose spiral computed tomography (LDCT) on lung cancer mortality. Secondary endpoints are incidence, stage at diagnosis, and resectability. Methods: Male subjects, aged 60 to 75 years, smokers of 20 or more pack-years, were randomized to screening with LDCT or control groups. All participants underwent a baseline, once-only chest X-ray and sputum cytology examination. Screening-arm subjects had LDCT upon accrual to be repeated every year for 4 years, whereas controls had a yearly medical examination only. Measurements and Main Results: A total of 2,811 subjects were randomized and 2,472 were enrolled (LDCT, 1,276; control, 1,196). After a median follow-up of 33 months, lung cancer was detected in 60 (4.7%) patients receiving LDCT and 34 (2.8%) control subjects (P = 0.016). Resectability rates were similar in both groups. More patients with stage I disease were detected by LDCT (54 vs. 34%; P = 0.06) and fewer cases were detected in the screening arm due to intercurrent symptoms. However, the number of advanced lung cancer cases was the same as in the control arm. Twenty patients in the LDCT group (1.6%) and 20 controls (1.7%) died of lung cancer, whereas 26 and 25 died of other causes, respectively. Conclusions: The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.

Original languageEnglish
Pages (from-to)445-453
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume180
Issue number5
DOIs
Publication statusPublished - Sep 1 2009

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Spiral Computed Tomography
Early Detection of Cancer
Lung Neoplasms
Arm
Mortality
Sputum
Cell Biology
Thorax
X-Rays
Technology
Control Groups
Incidence

Keywords

  • Early diagnosis
  • Lung neoplasms
  • Randomized controlled trial
  • Screening
  • Spiral computed tomography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

A randomized study of lung cancer screening with spiral computed tomography : Three-year results from the DANTE trial. / Infante, Maurizio; Cavuto, Silvio; Lutman, Fabio Romano; Brambilla, Giorgio; Chiesa, Giuseppe; Ceresoli, Giovanni; Passera, Eliseo; Angeli, Enzo; Chiarenza, Maurizio; Aranzulla, Giuseppe; Cariboni, Umberto; Errico, Valentina; Inzirillo, Francesco; Bottoni, Edoardo; Voulaz, Emanuele; Alloisio, Marco; Destro, Anna; Roncalli, Massimo; Santoro, Armando; Ravasi, Gianluigi.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 180, No. 5, 01.09.2009, p. 445-453.

Research output: Contribution to journalArticle

Infante, Maurizio ; Cavuto, Silvio ; Lutman, Fabio Romano ; Brambilla, Giorgio ; Chiesa, Giuseppe ; Ceresoli, Giovanni ; Passera, Eliseo ; Angeli, Enzo ; Chiarenza, Maurizio ; Aranzulla, Giuseppe ; Cariboni, Umberto ; Errico, Valentina ; Inzirillo, Francesco ; Bottoni, Edoardo ; Voulaz, Emanuele ; Alloisio, Marco ; Destro, Anna ; Roncalli, Massimo ; Santoro, Armando ; Ravasi, Gianluigi. / A randomized study of lung cancer screening with spiral computed tomography : Three-year results from the DANTE trial. In: American Journal of Respiratory and Critical Care Medicine. 2009 ; Vol. 180, No. 5. pp. 445-453.
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abstract = "Rationale: Screening for lung cancer with modern imaging technology may decrease lung cancer mortality, but encouraging results have only been obtained in uncontrolled studies. Objectives: To explore the effect of screening with low-dose spiral computed tomography (LDCT) on lung cancer mortality. Secondary endpoints are incidence, stage at diagnosis, and resectability. Methods: Male subjects, aged 60 to 75 years, smokers of 20 or more pack-years, were randomized to screening with LDCT or control groups. All participants underwent a baseline, once-only chest X-ray and sputum cytology examination. Screening-arm subjects had LDCT upon accrual to be repeated every year for 4 years, whereas controls had a yearly medical examination only. Measurements and Main Results: A total of 2,811 subjects were randomized and 2,472 were enrolled (LDCT, 1,276; control, 1,196). After a median follow-up of 33 months, lung cancer was detected in 60 (4.7{\%}) patients receiving LDCT and 34 (2.8{\%}) control subjects (P = 0.016). Resectability rates were similar in both groups. More patients with stage I disease were detected by LDCT (54 vs. 34{\%}; P = 0.06) and fewer cases were detected in the screening arm due to intercurrent symptoms. However, the number of advanced lung cancer cases was the same as in the control arm. Twenty patients in the LDCT group (1.6{\%}) and 20 controls (1.7{\%}) died of lung cancer, whereas 26 and 25 died of other causes, respectively. Conclusions: The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.",
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AU - Infante, Maurizio

AU - Cavuto, Silvio

AU - Lutman, Fabio Romano

AU - Brambilla, Giorgio

AU - Chiesa, Giuseppe

AU - Ceresoli, Giovanni

AU - Passera, Eliseo

AU - Angeli, Enzo

AU - Chiarenza, Maurizio

AU - Aranzulla, Giuseppe

AU - Cariboni, Umberto

AU - Errico, Valentina

AU - Inzirillo, Francesco

AU - Bottoni, Edoardo

AU - Voulaz, Emanuele

AU - Alloisio, Marco

AU - Destro, Anna

AU - Roncalli, Massimo

AU - Santoro, Armando

AU - Ravasi, Gianluigi

PY - 2009/9/1

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N2 - Rationale: Screening for lung cancer with modern imaging technology may decrease lung cancer mortality, but encouraging results have only been obtained in uncontrolled studies. Objectives: To explore the effect of screening with low-dose spiral computed tomography (LDCT) on lung cancer mortality. Secondary endpoints are incidence, stage at diagnosis, and resectability. Methods: Male subjects, aged 60 to 75 years, smokers of 20 or more pack-years, were randomized to screening with LDCT or control groups. All participants underwent a baseline, once-only chest X-ray and sputum cytology examination. Screening-arm subjects had LDCT upon accrual to be repeated every year for 4 years, whereas controls had a yearly medical examination only. Measurements and Main Results: A total of 2,811 subjects were randomized and 2,472 were enrolled (LDCT, 1,276; control, 1,196). After a median follow-up of 33 months, lung cancer was detected in 60 (4.7%) patients receiving LDCT and 34 (2.8%) control subjects (P = 0.016). Resectability rates were similar in both groups. More patients with stage I disease were detected by LDCT (54 vs. 34%; P = 0.06) and fewer cases were detected in the screening arm due to intercurrent symptoms. However, the number of advanced lung cancer cases was the same as in the control arm. Twenty patients in the LDCT group (1.6%) and 20 controls (1.7%) died of lung cancer, whereas 26 and 25 died of other causes, respectively. Conclusions: The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.

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KW - Early diagnosis

KW - Lung neoplasms

KW - Randomized controlled trial

KW - Screening

KW - Spiral computed tomography

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