Does Intense Monitoring After Colorectal Cancer Resection Bring Benefits?
Is it necessary to intensely monitor patients with colorectal cancer after curative resection? Not always, as shown by the results of the PRODIGE 13 study presented at the virtual ESMO 2020 conference.
Intense Monitoring After Curative Surgery
Professional societies recommend intense monitoring of patients with colorectal cancer (CRC) after curative surgery. These recommendations are largely based on expert opinions, while the results of several clinical studies are controversial. Furthermore, no better overall survival has been observed.
Study Methodology and Progress
PRODIGE 13 is a prospective multicenter randomized study evaluating the impact of intense monitoring on patients after complete CRC resection in stages II and III with no evidence of residual disease post-surgery. A total of 1995 patients were included (75.9% younger than 75 years, 16% had rectal cancer, 44% had left-sided colon cancer) and were randomly allocated to intense radiological follow-up (CT scan every 6 months) or standard follow-up (abdominal ultrasound every 3 months and chest X-ray every 6 months), with or without carcino-embryonic antigen (CEA) level determination.
Results
The median follow-up of the included subjects was 6.5 years. During this time, 22% of patients had a recurrence and 1.7% had a second occurrence of CRC.
In the case of colon cancer (CC) recurrence, 8.4% were localized, 74.7% were metastatic, and 15.7% were localized with metastases. In case of recurrence, subsequent treatment was conducted with a curative intent in 86.7% of patients with localized disease, 52.3% with metastatic disease, and in 44.6% of localized disease cases with detectable metastases.
A curative surgical procedure was performed in 40.9% of patients with minimal previous disease monitoring (standard monitoring without CEA determination), 66.3% with CEA determination and standard monitoring, 50.7% of participants whose disease was intensely monitored but without CEA determination, and 59.5% of patients monitored intensely with CEA determination (p = 0.0035).
For rectal cancer recurrences, 19.3% were localized, 65% metastatic, and 15.7% both types. These patients were treated with curative intent in 50% of localized, 53.7% of metastatic, and 38.5% of both types of cases. A curative surgical procedure was performed in 42.9% of participants with standard monitoring without CEA determination, 57.9% with CEA determination and standard monitoring, 55% of patients monitored intensely but without CEA determination, and 47.8% of participants monitored intensely with CEA determination (non-significant).
No difference in overall survival was observed in any of the groups (second interim analysis, 455 events).
Conclusion
Although the intensity of monitoring patients after therapeutic resection varied, no significant benefit was observed from additional CEA determination and/or regular CT examinations in terms of 5-year overall survival achieved. However, more intense monitoring after the completion of initial oncological treatment allowed a greater number of patients to undergo curative surgery in the event of a recurrence.
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Source: Lepage C., Phelip J. M., Cany L. et al. Effect of 5 years of imaging and CEA follow-up to detect recurrence of colorectal cancer: PRODIGE 13 a FFCD phase III trial. ESMO Virtual Congress 2020, abstract 3980.
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