Intensive follow-up after colorectal cancer treatment associated with increased recurrence detection

Image: PD 

1. Regular CEA testing and CT imaging found more surgically curable recurrences than no scheduled follow-up 

2. Intensive follow-up did not lead to a mortality benefit compared to no scheduled follow-up 

Evidence Rating Level: 2 (Good)      

Study Rundown: Previous research has suggested that serum CEA (carcinoembryonic antigen) measurement and CT imaging are the preferred methods to detect isolated metastatic recurrences of colorectal cancer. The appropriate follow-up regimen after curative treatment, however, is unclear. This study (the FACS—Follow-up After Colorectal Surgery trial) identified the ability to detect surgically treatable and curable recurrences. The authors found that regular follow-up with CEA testing, CT imaging, both individually and together, increased detection of such recurrences compared to no scheduled follow-up. No mortality benefit was found, and this was likely due to the study being underpowered—it had 31% power to detect a 5% effect on survival. Overall, this study provides evidence for improved recurrence detection using CT imaging and CEA testing.

Click to read the study, published today in JAMA

Relevant Reading: Postoperative surveillance in patients with colorectal cancer who have undergone curative resection: a prospective, multicenter, randomized, controlled trial

In-Depth [randomized controlled trial]: This clinical trial randomized 1,211 patients who had previously received curative treatment for primary colorectal cancer to one of four follow-up groups: 1) CEA follow-up, 2) CT follow-up, 3) CEA and CT follow-up, and 4) minimum follow-up. All participants underwent a pre-trial colonoscopy to assess any remaining disease and were followed at varying intervals depending on the assigned group for three years. All three groups with more intensive follow-up had greater curative surgical treatment of recurrence than those assigned to the minimum follow-up group (absolute difference 6.6-8.0%, p=0.02). However, the detection difference between CEA and CT only (OR 5.10 and 6.71, respectively) relative to minimum follow-up was not significantly different than the detection difference of combined CEA and CT group (OR 5.24) relative to minimum follow-up. Moreover, no mortality benefit was found between intensive follow-up by any method and minimum follow-up (p=0.35).

By Jonathan Lichkus and Rif Rahman

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