Lung Surveillance Strategy for High-Grade Soft Tissue Sarcomas: Chest X-Ray or CT Scan? Journal of the American College of Surgeons Gamboa, A. C., Ethun, C. G., Switchenko, J. M., Lipscomb, J. n., Poultsides, G. A., Grignol, V. n., Howard, J. H., Gamblin, T. C., Roggin, K. K., Votanopoulos, K. n., Fields, R. C., Maithel, S. K., Delman, K. A., Cardona, K. n. 2019


Given the propensity for lung metastases (LM), NCCN guidelines recommend lung surveillance (LS) with either CXR or CT in high-grade soft tissue sarcoma (HG-STS). Considering survival, diagnostic sensitivity and cost, the optimal modality is unknown.The US Sarcoma Collaborative database (2000-2016) was reviewed for patients who underwent resection of a primary HG-STS. Primary outcome was overall survival (OS). Cost analysis was performed.Among 909pts, 83% had truncal/extremity, 17% had retroperitoneal (RP) tumors. Recurrence occurred in 48% of which 54% were LM. LS was performed with CT in 80% and CXR in 20%. Both groups were clinically similar although CT patients had more RP tumors and recurrences. Regardless of modality, 85-90% of LM were detected within the first 2yrs with a similar re-intervention rate. When considering age, tumor size, location, margin status, and receipt of radiation, LM was independently associated with worse OS(HR:4.26; p<0.01) while imaging modality was not(HR:1.01; p=0.97). CXR patients did not have an inferior 5-year OS compared to CT(71vs60%, p<0.01). When analyzing patients in whom no LM was detected, both cohorts had a similar 5-year OS(73vs74%, p=0.42), suggesting CXR was not missing clinically relevant lung nodules. When adhering to a guideline-specified protocol for 2018 projected 4,406 cases, surveillance with CXR for 5yrs results in savings of $5-8M/year to the US healthcare system.In this large multicenter study, LS with CXR did not result in worse overall survival when compared to CT. With considerable savings, a CXR-based protocol may optimize resource utilization for LS in HG-STS; prospective trials are needed.

View details for DOI 10.1016/j.jamcollsurg.2019.07.010

View details for PubMedID 31377411