NELSON
Trial question
What is the role of low-dose CT screening in individuals at high risk for lung cancer?
Study design
Multi-center
Open label
RCT
Population
13195 male patients.
Inclusion criteria: individuals at high risk for lung cancer.
Key exclusion criteria: moderate or severe health problems and an inability to climb two flights of stairs; body weight > 140 kg; current or past renal cancer, melanoma, or breast cancer; diagnosis of lung cancer or treatment related to lung cancer within the past 5 years; chest CT within the past year.
Interventions
N=6583 CT (low-dose 16-multidetector or, in later rounds, 64-multidetector CT systems used to acquire isotropic volume data).
N=6612 no screening (no CT).
Primary outcome
Incidence of death from lung cancer at 10 years
2.5
3.3
3.3/1000 py
2.5/1000 py
1.6/1000 py
0.8/1000 py
0.0/1000 py
Computed
tomography
No
screening
Significant
decrease ▼
Significant decrease in the incidence of death from lung cancer at 10 years (2.5/1000 py vs. 3.3/1000 py; RR 0.76, 95% CI 0.61 to 0.94).
Secondary outcomes
No significant difference in the incidence of lung cancer at 10 years (5.58/1000 py vs. 4.91/1000 py; RR 1.14, 95% CI 0.97 to 1.33).
No significant difference in the incidence of all-cause mortality at 10 years (13.93/1000 py vs. 13.76/1000 py; RR 1.01, 95% CI 0.92 to 1.11).
No significant difference in death from other neoplasms (36.6% vs. 33.6%; RR 1.1, 95% CI 0.94 to 1.3).
Conclusion
In individuals at high risk for lung cancer, CT was superior to no screening with respect to the incidence of death from lung cancer at 10 years.
Reference
Harry J de Koning, Carlijn M van der Aalst, Pim A de Jong et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020 Feb 6;382(6):503-513.
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