Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT.
BACKGROUND
Results of randomized clinical trials (RCTs) are needed to assess the efficacy of lung cancer screening with low-dose chest computed tomography (CT) in reducing lung cancer mortality. We report design and results of enrolment and baseline screening test in the ITALUNG trial, a RCT.


METHODS
Invitation letters were sent to subjects of 55-69 years of age clients of 269 general practitioners. Smokers or former smokers of at least 20 pack/years were eligible and after written consent were randomized in an active arm undergoing a low-dose CT annually for 4 years and in a control arm receiving no screening. Management of positive screening test was carried out using follow-up low-dose CT, fluorodeoxyglucose positron emission tomography, fine needle aspiration cytology and fiber optic bronchoscopy.


RESULTS
A sample of 3206 eligible subjects was achieved by sending 71,232 letters (enrolment efficacy = 4.5%). Subjects in control (n = 1593) and active (n = 1613) arm were balanced for age, gender and smoking history. Two-hundred and seven (12.8%) subjects did not undergo CT after randomization. The baseline screening test was positive in 426 (30.3%) of 1406 subjects. Twenty-one lung cancers (prevalence = 1.5%) were found in 20 subjects: 18 non-small cell lung cancer (NSCLC), 2 small cell lung cancer (SCLC) and a case of typical carcinoid. Ten NSCLC (47.6%) were in Stage I. Sixteen fine needle aspirations were performed in 15 lung cancers, with a positive result in 12 (75%) cases. One biopsy only (6.3%) was performed on a benign lesion. Seventeen lung cancers (81%) were treated with surgical resection in 16 subjects. One subject underwent surgery for a benign lesion (5.5% of all surgical resections).


CONCLUSIONS
Recruitment by mail of high risk subjects for a lung cancer screening RCT is feasible but not efficient. Results of the baseline screening test in the active arm of the ITALUNG trial are substantially in line with those of RCT and observational studies.
Lopes Pegna
Andrea
A
Pneumology Department, Careggi Hospital, Florence, Italy. lopespegnaa@ao-careggi.toscana.it
Picozzi
Giulia
G
Mascalchi
Mario
M
Maria Carozzi
Francesca
F
Carrozzi
Laura
L
Comin
Camilla
C
Spinelli
Cheti
C
Falaschi
Fabio
F
Grazzini
Michela
M
Innocenti
Florio
F
Ronchi
Cristina
C
Paci
Eugenio
E
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology; D000368:Aged; D044963:Biopsy, Fine-Needle; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000453:epidemiology; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005336:Fiber Optic Technology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011829:Radiation Dosage; D012107:Research Design; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18