Surveillance after curative treatment for CRC

Regular CEA (carcinoembryonic antigen) assessment is not needed to detect recurrence of colorectal cancer (CRC) and CT scans should only be performed in cases of suspected recurrence, preliminary results of the phase 3 PRODIGE 13 trial showed [1].

Intensive follow-up of patients after curative surgery for CRC is recommended by various scientific societies. PRODIGE 13 is a prospective, multicentre, controlled trial in which 1,995 patients were double randomised in the follow-up of resected stage II or III CRC with no evidence of residual disease on post-surgical investigation. First randomisation was to intensive radiological monitoring (CT scan every 3 months for 3 years, then biannually for 2 years) versus a standard one (abdominal ultrasound every 3 months for 3 years, then biannually for 2 years and thoracic radiography every 6 month for 5 years). Second randomisation was to CEA assessment (every 3 months for 2 years, then biannually for 3 years) versus no CEA assessment.

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 randomised arms (see Figure).

Figure: 5-year overall survival by randomisation arms [1]

1. Lepage C, et al. Effect of 5 years of imaging and CEA follow-up to detect recurrence of colorectal cancer (CRC) - PRODIGE 13 a FFCD phase III trial. ESMO 2020 Virtual Meeting, abstract 398O.

Posted on 25 November 202017 May 2024