scholarly journals Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

2017 ◽  
Vol 36 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Robert R.J. Coebergh van den Braak ◽  
Zarina S. Lalmahomed ◽  
Stefan Büttner ◽  
Bettina E. Hansen ◽  
Jan N.M. Ijzermans ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Disease Recurrence ◽  
Added Value ◽  
First Year ◽  
Minimal Group ◽  
Surveillance Programs ◽  
Intensive Group ◽  
Nonphysician Clinicians ◽  
Multifocal Disease

Background/Aims: The 5-year postoperative follow-up for patients undergoing curative treatment for colorectal cancer (CRC) is labour intensive. We assessed the added value of a dedicated nonphysician clinician (NPC) in the follow-up of patients after resection for CRC. Methods: Patients were divided into 2 groups as defined by the number of follow-up visits in the first year, including intensive (≥3×) and minimal (≤2×). Involvement of an NPC, diagnosis of disease recurrence and the course of the disease were determined. Results: Of the 681 patients, 79.9% belonged to the “intensive” and 21.1% to the “minimal” group. Involvement of an NPC resulted in a higher adherence to follow-up (84.3 vs. 73.9%, p = 0.001). Overall, patients in regular follow-up less often had multifocal recurrence (47.1 vs. 73.7%, p = 0.04), and a better survival after recurrence (SAR; hazard ratio [HR] 3.604, p < 0.001). The “intensive” group had a significantly better overall survival compared to the “minimal” group (HR 1.71, p = 0.013). Conclusion: Adherence to surveillance programs after resection for CRC is better in hospitals with a dedicated NPC. Overall, patients' adherence to follow-up resulted in less multifocal disease recurrence at the time of diagnosis as compared to patients presenting with symptoms and a better 3-year SAR.

scholarly journals CEA as a prognostic index in colorectal cancer

1997 ◽  
Vol 115 (6) ◽  
pp. 1589-1592 ◽  
Author(s):  
Nora Manoukian Forones ◽  
Marcelo Tanaka ◽  
Jeane Brito Falcão
Keyword(s):  
Colorectal Cancer ◽  
Carcinoembryonic Antigen ◽  
Prognostic Index ◽  
Tumor Stage ◽  
Disease Recurrence ◽  
High Serum ◽  
First Year ◽  
Additional Information ◽  
Serum Cea

INTRODUCTION: The carcinoembryonic antigen, CEA, is the tumor marker most used in colorectal patients, principally during follow up after radical surgery. High serum CEA level before surgery is often associated with worse prognosis, in some studies. OBJECTIVE: The purpose of this study was to evaluate the preoperative carcinoembryonic antigen levels (CEA) and the frequency of recurrence. MATERIAL AND METHODS: Eighty-three patients with colorectal cancer at Dukes stages A, B or C were evaluated retrospectively. The patients' follow up was at least two years or to death. CEA was detemined in serum by enzyme immunoassay (Sorin Biomedica), normal value 0-5ng/mI. RESULTS: Disease recurrence was observed in 32 patients (38.5%), 13 Dukes B and 19 Dukes C. Seventy five per cent of the patients with CEA higher than 10ng/ml relapsed and 80% of the patients without recurrence had normal CEA. Disease recurrence in patients with preoperative elevated CEA occurred during the first year of follow up in 56% of the patients. CONCLUSION: Although the tumor stage is today the most valuable prognostic variable in colorectal cancer, the preoperative CEA value can provide some additional information in the prognosis of the patient.

Characteristics and results of treatment of patients treated surgically with colorectal cancer in old and senile age

2018 ◽  
Vol 90 (1) ◽  
pp. 1-6
Author(s):  
Zbigniew Banaszkiewicz ◽  
Tomasz Zwoliński ◽  
Krzysztof Tojek ◽  
Paweł Jarmocik ◽  
Arkadiusz Jawień
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Old Age ◽  
Colonic Cancer ◽  
First Year ◽  
Overall Survival Rate ◽  
Younger Patients ◽  
Results Of Treatment

Colorectal cancer (CC) in Poland is the type of cancer with the highest dynamics of disease growth and is epidemiologically related to age. The analysis involved 353 patients operated on due to CC in senile and old age and compared with younger patients. It was found that people at this age are more often diagnosed with CC They were more often women, the patients did not differ in the stage of cancer, while they were significantly more often qualified for surgery due to urgent indications. In patients with colonic cancer, the resectability and radicality of the procedures in comparison with patients with rectal cancer was significantly higher, while there were more complications and deaths in the 30-day follow-up in this group. The overall survival in senile and old age was significantly worse. In the first year of follow-up after surgical treatment of patients in this group, complications and deaths were more frequently observed. However, in patients who survived 12 months after the operation, the overall survival rate did not significantly differ.

Intensive CT scan surveillance for patients who have undergone curative intent treatment for colorectal cancer: The Medstar Washington Hospital Center experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14675-e14675 ◽  
Author(s):  
Konstantinos Leventakos ◽  
Stanlee Santos Lu ◽  
David John Perry
Keyword(s):  
Colorectal Cancer ◽  
Ct Scan ◽  
Survival Data ◽  
Stage I ◽  
First Year ◽  
Curative Intent ◽  
Serial Measurement ◽  
A Prospective Study ◽  
Hospital Center

e14675 Background: The current ASCO guideline for surveillance after curative intent treatment of colorectal cancer is yearly CT scan of the chest, abdomen and pelvis with every 3-6 months history and physical exam and serial measurement of Carcinoembryonic antigen (CEA). The benefit of doing more intensive CT scan surveillance has not been adequately substantiated. Methods: Data of patients with resectable stage I-III colorectal cancer treated at Medstar Washington Hospital Center from January 2000-June 2012 were retrospectively reviewed. Epidemiologic, histopathologic , surveillance schedule (CT scan and CEA), and survival data were analyzed. Our institutional standard was to obtain CT scans every 3 months for the first year, every 6 months for the second year and then yearly for years 3-5. Results: Thirty-three patients with adequate documentation were included. The mean age of the patients was 59.6 years at diagnosis, 55% were female and 78% ethnically African American. 6% were in stage I, 37% were in stage II and 57% in stage III. CT scan was used in 100% of the patients done with a median interval of 7 months. At follow up, 28 (85%) patients had recurrence at a median of 21.6 months from surgery. 67% had recurrence in the liver. 96% of these recurrences were diagnosed primarily by CT scan and only 1 patient (3%) was diagnosed with MRI of the liver following an elevated CEA with a negative CT scan. Only 50% of patients with recurrence had an elevated CEA. 54% of patients with recurrence were able to undergo curative treatment (resection and/or chemotherapy). Conclusions: In this single institution, retrospective review, CT scan surveillance was utilized more frequently than specified in current ASCO guidelines. CEA screening alone would have missed 50% of patients with potentially curable recurrent cancer. Our data shows that more intensive CT scan surveillance led to earlier detection of recurrences that allowed patients to undergo curative intent treatment. A prospective study is warranted to further support this finding.

Time course and outcome of central recurrence after radiation therapy for carcinoma of the cervix

2006 ◽  
Vol 16 (3) ◽  
pp. 1106-1111 ◽  
Author(s):  
P. J. Eifel ◽  
A. Jhingran ◽  
J. Brown ◽  
C. Levenback ◽  
H. Thames
Keyword(s):  
Survival Rate ◽  
Hazard Rate ◽  
Time Course ◽  
Figo Stage ◽  
Disease Recurrence ◽  
Early Recurrence ◽  
First Year ◽  
Poor Survival ◽  
Actuarial Risk

We investigated the time course of central disease recurrence (CDR) in 2997 patients treated with radiation for stage I–II squamous cell carcinoma of the cervix. CDR rates were 6.8%, 7.8%, and 9.6%, at 5, 10, and 20 years, respectively. The risk of CDR was independently correlated with tumor size (P < 0.0001) but not with FIGO stage. The hazard rate peaked in the first year of follow-up and then fell steeply; after 3 years, the hazard rate was approximately constant at 0.2–0.4% per year. Although after 3 years the risk of CDR was low, it continued to be slightly greater for patients with tumors ≥5 cm than for those with smaller tumors (P = 0.001). Patients who had CDR <36 months after treatment were less likely to be candidates for salvage therapy and had a poorer postrecurrence survival rate than those with recurrence ≥36 months after treatment (4.5% versus 42.1%, P < 0.0001). The higher rate of CDR in the first 3 years and the poor survival after early recurrence suggest that most early CDRs are true relapses. The relatively stable annual actuarial risk between 3 and 25 years and the better survival rate after late CDR suggest that most “recurrences” after 3 years are actually new neoplasms.

Evaluation of routine image follow-up in nonmetastatic colorectal cancer after curative surgical resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 524-524
Author(s):  
Lara Azevedo Diniz ◽  
Amanda Karani ◽  
Diogo De Brito Sales ◽  
Larissa Machado ◽  
Milton Jose Barros
Keyword(s):  
Colorectal Cancer ◽  
Disease Recurrence ◽  
Early Recurrence ◽  
Primary Treatment ◽  
Cancer Center ◽  
Published Data ◽  
Ct Image ◽  
Survival Difference ◽  
Pattern Of Recurrence

524 Background: Follow-up surveillance is performed after primary treatment in colorectal cancer (CRC), but it is controversial in the literature the real benefit of an intensive examination in terms of outcomes and resources. Intensive follow-up after surgery for colorectal cancer has been challenged by some new published data (CEA watch trial and FACS trial). These new data suggest that a less intensive follow-up program based on carcinoembryonic antigen (CEA) measurements or CEA-Triggered imaging would be enough to detected most of the recurrences. We believe that there is a high percentage of patients with recurrence disease and normal CEA value, for whom image screening would be necessary to detect early disease recurrence suitable to metastasectomy with curative intention. Methods: This is a retrospective study that included 372 patients from a tertiary cancer center in São-Paulo (Brazil) diagnosed with colorectal adenocarcinoma stages I to III. We observed, after primary treatment, a pattern of recurrence detected either by CT (computed tomography) imaging only or CEA elevation and CT image in combination. Results: Out of the 372 patients analyzed, 110 (29,5%) had recurrent disease with a median follow-up time of 34 months. Of the 110 recurrences detected, 75 (68,18%) were detected by CEA elevation in combination with CT image, 33 (30%) were detected only by CT image and 2 (1,81%) neither by CT nor by CEA alteration. There was no clinic feature that would predict pattern of recurrence when analyzed by qui square test. Metastasectomy rate from this analysis 53,6% and it was similar among both groups. Recurrence rate after metastasectomy was 59,3%. There is a 5-year overall survival difference between patients that underwent or not metastasectomy (79,4% vs. 54%, p 0,01). Conclusions: CEA-based follow-up program and CEA-triggered imaging failed to detect early recurrence in almost 30% of cases. We believe that this number is high enough to allow us to continue to perform image test during CRC follow-up.

Determining optimal follow up for patients with anal cancer following chemoradiation.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 689-689
Author(s):  
Marissa Frazer ◽  
George Q Yang ◽  
Seth Felder ◽  
Julian Sanchez ◽  
Sophie Dessureault ◽  
...  
Keyword(s):  
Health Care ◽  
Anal Carcinoma ◽  
High Volume ◽  
Disease Recurrence ◽  
First Year ◽  
High Volume Center ◽  
High Control ◽  
Cancer Network

689 Background: U.S. health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical especially in cancers treated with high control rates. The objective of this study was to assess time to disease recurrence or toxicity in a cohort of patients with anal carcinoma in order to optimize patient care. Methods: 140 patients diagnosed with biopsy-proven, non-metastatic anal carcinoma, treated with chemoradiation utilizing IMRT, were identified from an institutional database at our high volume center. After IRB approval, a retrospective study was conducted that evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥ grade three toxicity (LG3T) based on National Cancer Institute Common Terminology for Adverse Events version 4. Patients were followed post-treatment every three months for two years, every six months in years 3-5 then yearly thereafter with imaging per National Comprehensive Cancer Network recommendations. Results: Median age and follow up is 58 years and 27 months, respectively. Patients were staged based on AJCC 8th edition and 24 patients were stage I (17%), 55 stage II (39%) and 61 stage III (44%). The median radiation dose was 54 Gy (range: 40-62.5), and 11% of patients required a radiation break. The two year LC, DMFS, and OS were 93%, 94% and 89% and 5-year LC, DMFS, OS were 92%, 87% and 85% respectively. In total, there were 29 disease or treatment related events: LR occurred in nine patients, DM in 11 patients, and LG3T in nine patients. Overall, 62% of events occurred within year one and 77 % within two years. Stratified by event type, at two years 79% of LR, 64% of DM and 89% LG3T were identified. At the remaining follow-up points after 2 years there was an event incidence rate of 1.4%. Conclusions: The majority of recurrences/toxicities in patients diagnosed with non-metastatic anal carcinoma after chemoradiation occur within the first year, with 77% of any event occurring before year two. The data from individual time points suggest a reduction in follow-up during years 3-5 may provide adequate surveillance. Considering revisions of the current follow-up recommendations could maximize health care resources while also improving patient quality of life.

scholarly journals Plasma microRNA Levels Combined with CEA and CA19-9 in the Follow-Up of Colorectal Cancer Patients

Cancers ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 864 ◽  
Author(s):  
Martin Pesta ◽  
Radek Kucera ◽  
Ondrej Topolcan ◽  
Marie Karlikova ◽  
Katerina Houfkova ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Plasma Levels ◽  
Quantitative Estimation ◽  
High Specificity ◽  
Disease Recurrence ◽  
Palliative Surgery ◽  
Surgical Removal ◽  
Plasma Microrna ◽  
Low Sensitivity

Colorectal cancer (CRC) ranks among the most common cancers worldwide. Surgical removal remains the best strategy for treatment of resectable tumors. An important part of caring for patients after surgery is monitoring for early detection of a possible relapse of the disease. Efforts are being made to improve the sensitivity and specificity of routinely used carcinoembryonic antigen (CEA) with the use of additional biomarkers such as microRNAs. The aim of our study was to evaluate the prognostic potential of microRNAs and their use as markers of disease recurrence. The quantitative estimation of CEA, CA19-9, and 22 selected microRNAs (TaqMan Advanced miRNA Assays) was performed in 85 paired (preoperative and postoperative) blood plasma samples of CRC patients and in samples taken during the follow-up period. We have revealed a statistically significant decrease in plasma levels for miR-20a, miR-23a, miR-210, and miR-223a (p = 0.0093, p = 0.0013, p = 0.0392, and p = 0.0214, respectively) after surgical removal of the tumor tissue. A statistically significant relation to prognosis (overall survival; OS) was recorded for preoperative plasma levels of miR-20a, miR-21, and miR-23a (p = 0.0236, p = 0.0316, and p =0.0271, respectively) in a subgroup of patients who underwent palliative surgery. The best discrimination between patients with favorable and unfavorable outcomes was achieved by a combination of CEA, CA19-9 with miR-21, miR-20a, and miR-23a (p < 0.0001). The use of these microRNAs for early disease recurrence detection was affected by a low specificity in comparison with CEA and CA19-9. CEA and CA19-9 had high specificity but low sensitivity. Our results show the benefit of combining currently used standard biomarkers and microRNAs for precise prognosis estimation.

Effect of PET-CT on disease recurrence and its management in patients with potentially resectable colorectal cancer liver metastases: The long-term results of a randomized control trial.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 562-562
Author(s):  
Pablo Emilio Serrano Aybar ◽  
Chu-Shu Gu ◽  
Mohamed Husien ◽  
Diederick Jalink ◽  
Guillaume Martel ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Surgical Management ◽  
Disease Recurrence ◽  
Long Term Results ◽  
Colorectal Cancer Liver Metastases ◽  
Pet Ct ◽  
Risks Factors

562 Background: The PETCAM randomized trial evaluated the effect of preoperative PET-CT (vs. no PET-CT) on surgical management in patients with colorectal cancer liver metastases. In this study, 8% of patients had a change in surgical management, including a higher proportion of major liver resections in the PET-CT arm. The current study compares the intervention groups for 5-year disease free (DFS) and overall survival (OS), and evaluated their long-term clinical course, i.e. sites of recurrence and management of disease recurrence. Methods: Recruitment to the trial occurred between 2005-2010, with last follow-up in 2013. Data on recurrence, management of recurrence and mortality from 2013-2017 was collected from patient’s charts. Recurrences according to site and management were described. Cox proportional Hazard Models were used to calculate the risk for recurrence and death. OS was calculated with Kaplan-Meir method and compared with log-rank test. Results: At 5 years, 157 of 404 (39%) patients were still alive and 19 patients were lost to follow-up. Median follow-up is 4.2 years. There were no differences in DFS (HR: 1.12, 95%CI: 0.88-1.42) or OS (HR: 0.97, 95%CI: 0.74-1.28) between groups. The median DFS for the 372 patients who had surgery was 17 months, 95%CI: 14.7-19.4. Risks factors for recurrence were: extrahepatic disease, liver tumour size, and nodal stage. The median OS for all patients was 50 months, 95%CI: 43.5-64.3. Risks factors for death also included age and prior use of chemotherapy. During the follow-up period, 287/404, 71% patients recurred (mostly liver and lung); 137 (48%) were treated solely with chemotherapy and 35% were treated with surgery with curative intent. Of these, the majority recurred (109/116, 94%). The median OS following first recurrence was 27.5 months, 95%CI: 23-30. Conclusions: PET-CT did not improve DFS or OS. Survival following liver resection is similar to previous reports, however most patients experience disease recurrence. A substantial proportion of patients who recur undergo surgery, however it is likely that they will recur again.

scholarly journals Survivorship in Colorectal Cancer: A Cohort Study of the Patterns and Documented Content of Follow-Up Visits

2020 ◽  
Vol 9 (9) ◽  
pp. 2725
Author(s):  
Victoria Garwood ◽  
Karolina Lisy ◽  
Michael Jefford
Keyword(s):  
Colorectal Cancer ◽  
Care Physician ◽  
First Year ◽  
Survivorship Care ◽  
Audit Tool ◽  
Health Checks ◽  
Study Population ◽  
Care Guidelines ◽  
Physical Changes

Survivors of colorectal cancer (CRC) may experience a range of physical, psychosocial, and practical challenges as a consequence of their diagnosis. We assessed the patterns and documented content of follow-up visits within the first three years following treatment, in comparison to survivorship care guidelines. Survivors with stage I-III CRC who underwent curative resection at Peter MacCallum Cancer Centre from July 2015 to January 2018 were followed for up to 1080 days. Patterns of follow-up were calculated by recording the date and specialty of each visit; documented content was assessed using a study-specific audit tool for the first year (360 days) of follow-up. Forty-eight survivors comprised the study population, 34 of whom (71%) attended the recommended two to four follow-up visits in their first year. Visit notes documented new symptoms (96%), physical changes (85%), physical examination (63%), and investigations (56%–90%); none had documented discussions of screening for other primary cancers, or regular health checks and/or screening. Each survivor had at least one outpatient letter that was sent to their primary care physician, but responsibilities were not adequately defined (31%). Although survivors had regular follow-up in their first year, documentation did not consistently address aspects of wider survivorship care.

scholarly journals Characterisation of the Expression of Neurotensin and Its Receptors in Human Colorectal Cancer and Its Clinical Implications

Biomolecules ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 1145
Author(s):  
Shengyang Qiu ◽  
Stella Nikolaou ◽  
Jie Zhu ◽  
Peter Jeffery ◽  
Robert Goldin ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Histological Grade ◽  
Significant Risk ◽  
Disease Free Survival ◽  
Significant Risk Factor ◽  
Disease Recurrence ◽  
Cancer Tissue ◽  
Normal Epithelium ◽  
Free Survival

Introduction: Colorectal Cancer (CRC) accounts for 9% of cancer deaths globally. Hormonal pathways play important roles in some cancers. This study investigated the association of CRC expression of neurotensin (NTS), NTS receptors 1 and 3 (NTSR1 and NTSR3) and clinical outcomes. Methods: A prospective cohort study which quantifies the protein expression of NTS, NTSR1 and NTSR3 in human CRCs using immunohistochemistry. Expression levels were then compared with clinico-pathological outcome including histological grade, overall survival (OS) and disease-free survival (DFS). Results: Sixty-four patients were enrolled with median follow-up of 44.0 months. There was significantly higher expression of NTS in cancer tissue in CRC with higher T stages (p < 0.01), N stages (p = 0.03), and AJCC clinical stages (p = 0.04). There was significantly higher expression of NTS, NTSR1 and NTSR3 in cancer tissue compared to surrounding normal epithelium (median H-score 163.5 vs 97.3, p < 0.01). There was significantly shorter DFS in individuals with CRC with high levels of NTS compared to lower levels of NTS (35.8 months 95% CI 28.7–42.8 months vs 46.4 months 95% CI 42.2–50.5 months, respectively, p = 0.02). Above median NTS expression in cancer tissue was a significant risk factor for disease recurrence (HR 4.10, 95% CI 1.14–14.7, p = 0.03). Discussion: The expression of NTS and its receptors has the potential to be utilised as a predictive and prognostic marker in colorectal cancer for postoperative selection for adjuvant therapy and identify individuals for novel therapies targeting the neurotensinergic pathways. Conclusions: High NTS expression appears to be associated with more advanced CRC and worse DFS.

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