Intensive Monitoring Ups Surgical Treatment of CRC Recurrence
But no mortality reduction seen with intensive CEA screening, CT imaging, or both
WEDNESDAY, Jan. 15, 2014 (HealthDay News) -- For patients who have undergone curative surgery for primary colorectal cancer, intensive monitoring is associated with increased surgical treatment of recurrence compared with minimum follow-up, but does not reduce the number of deaths, according to a study published in the Jan. 15 issue of the Journal of the American Medical Association.
John N. Primrose, M.D., from the University of Southampton in the United Kingdom, and colleagues examined the effect of scheduled blood measurement of carcinoembryonic antigen (CEA) and computed tomography (CT) as follow-up for 1,202 eligible patients who underwent curative surgery for primary colorectal cancer. Participants were randomized to CEA only (300 patients), CT only (299 patients), CEA+CT (302 patients), or minimal follow-up (follow-up only in case of symptom occurrence; 301 patients).
After a mean of 4.4 years of observation, the researchers detected recurrence in 199 participants (16.6 percent) overall. Surgical treatment of recurrence with curative intent was undertaken in 5.9 percent of the cohort overall, with rates of 2.3 percent in the minimum follow-up group, 6.7 percent in the CEA group, 8 percent in the CT group, and 6.6 percent in the CEA+CT group. There was no significant difference in the number of deaths between the combined intensive monitoring groups (CEA, CT, CEA+CT, 18.2 percent) and the minimum follow-up group (15.9 percent; difference, 2.3 percent [95 percent confidence interval, −2.6 to 7.1 percent]).
"Among patients who had undergone curative surgery for primary colorectal cancer, intensive imaging or CEA screening each provided an increased rate of surgical treatment of recurrence with curative intent compared with minimal follow-up; there was no advantage in combining CEA and CT," the authors write.
One author disclosed financial ties to GP Update Ltd.
Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1814213#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1814213 )