Intensive Follow-up Increases Frequency of Curative Intent Secondary Surgery in Colorectal Cancer

Intensive follow-up is recommended to monitor patients with colorectal cancer (CRC) following curative surgery; however, the optimal diagnostic procedure is still uncertain, and survival benefits in clinical trials have not been consistently reported. At ESMO Virtual Congress 2020, the results of the PRODIGE 13 trial that compared two types of follow-up care on long-term survival of patients with CRC demonstrated that although neither approach provided overall survival (OS) benefits, intensive monitoring after curative surgery enabled more curative intent secondary surgeries (Abstract 398O).

PRODIGE 13, a prospective phase III multicentre trial conducted in France and Belgium, evaluated 5-year OS in 1,995 patients with fully resected stage 2/3 CRC who were double-randomised to intensive radiological monitoring (CT-scan every 6 months) versus standard monitoring (abdominal ultrasound every 3 months and thoracic radiography every 6 months) with or without carcinoembryonic antigen (CEA) assessments.

After a median follow-up of 6.5 years, 22% of patients had cancer recurrence and 1.7% of patients had a second CRC diagnosis. Despite differences in monitoring procedures, no differential OS benefits were noted between arms. Among patients with recurrence of colon cancer, 8.4%, 74.7% and 15.7% of cases were localised, metastatic, or both, respectively. Of these, more patients (86.7%) with localised disease were treated with curative intent than patients with metastatic disease (52.3%), or both (44.6%). The frequency of surgical treatment with curative intent was significantly different between arms in patients with colon cancer (p=0.0035), such that 59.5% of patients with intensive follow-up plus CEA assessments had secondary surgery, compared with 40.9% of those receiving standard imaging without CEA assessments, 66.3% of patients receiving standard imaging plus CEA, and 50.7% undergoing intensive follow-up with no CEA. In patients with recurrences of rectal cancer, 50% of those with localised disease, 53.7% with metastatic disease and 38.5% with both were treated with curative intent. Surgical treatment of recurrence was possible for 42.9–57.9% of these patients across arms (not statistically significant).

Optimisation of diagnostic procedures in terms of OS benefits remains to be determined; however, these results provide clear evidence for the effectiveness of intensive follow-up monitoring in enabling secondary surgery with curative intent in patients with CRC recurrence.

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