The Study: When you read the NCCN guidelines for colorectal cancer, you’ll get little guidance on surveillance. That’s because most post-treatment surveillance strategies are either extrapolated from intensive clinical trials or just plain made up. The COLOFOL trial randomized patients with resected stage II-III colorectal cancer to low versus high intensity post-treatment surveillance. These 2500 patients hailed from Denmark, Sweden, and…Uruguay, possibly having something to do with the World Cup semi-finals. “High” intensity surveillance included CEA and CT chest/abdomen at 6, 12, 18, 24, and 36 months. “Low" intensity included the same tests at only 12 and 36 months. Of note, patients had to be verifiably (read: colonoscopically) disease-free prior to enrollment, with scope exams at physician discretion thereafter. At 5 years, mortality, cancer-specific survival, and even detected recurrence rates were the same—all supported by an accompanying NCDB analysis. The much more confusing 2014 UK FACS trial came to somewhat similar conclusions, though the arms followed with CEA only had slightly higher mortality.
Bottom Line: CEA and CT chest/abdomen at 12 and 36 months is a reasonable surveillance approach for patients with stage II-III colorectal cancer who at treatment completion are disease-free, both by colonoscopy and normalization of CEA. | Wille-Jorgensen, JAMA 2018