Intensive radiographic and CEA screening and salvage resection in patients with stage II and III colorectal cancer.

Abstract

405 Background: The objective of this study was to determine the rate of salvage resection in patients with stage II and III colorectal cancer following intensive surveillance. Methods: Patients with stage II and III colorectal cancer with a minimum follow-up of 3 years were included. CEA was obtained every 3 months for 2 years and then every 6 months for years 3 to 5. CT of the chest, abdomen and pelvis was performed every 6 months for 2 years and then yearly for years 3 to 5. Colonoscopy was performed at year 1 and then every 3 years. Results: 177 patients were followed for a median of 59.5 months. 51% were male, and 65 % had colon cancer. Compliance with screening was excellent with 92 % of patients undergoing all scheduled studies within 2 months of the planned date. At the time of this report, the median follow-up of the overall population was 5 years. 44 patients were diagnosed with recurrent disease. 91% of the recurrences were in the first 3 years of follow-up. CT and CEA were the first signs of recurrence in 68% and 14% of patients, respectively. Among the 30 patients diagnosed radiographically, 20 had a normal CEA. 25 patients (57%) with recurrent disease underwent curative intent resection, 12 of whom are still cancer free, with a median follow-up of 6.7 years from salvage surgery. The DFS and OS in the operated recurrent population from the time of salvage resection was 18.8 months (95% CI: 15.5 – 29.4) and not-reached (95% CI: 37.4, NR), respectively. The corresponding OS (from the time of recurrence) of the recurrent population without resection was 20.7 months (95% CI: 21.9, 63.4). The difference in OS between the two groups was highly significant (p = 0.0003). Among the patients undergoing resection, a significant difference was detected in the DFS of resected lung or liver metastases vs. extra-hepatic/pulmonary disease (p = 0.03) and a trend towards improved survival was noted (p = 0.07). Conclusions: Our intensive surveillance strategy resulted in the highest reported salvage rate in stage II and III colorectal cancer and led to a high rate of sustained remissions following salvage surgery. Intensive, 6-monthly, radiographic surveillance and its duration should be investigated further in randomized studies.