Less may be more in postop colorectal cancer follow-up

Current guidelines are based on older data indicating that follow-up for patients with resected colorectal cancer adds as much benefit to overall survival as does adjuvant chemotherapy (hazard ratio 0.73) (Cochrane Database Syst Rev. 2007;CD002200). This conclusion may not reflect the outcomes associated with more current treatments.

Although FACS was of insufficient statistical power to estimate survival advantage, the lack of difference between the three intensive follow-up protocols challenges our current practice of repeated CT scans with their extra radiation exposure.

Clinicians also may want to rethink the emphasis on history and physical exam in the follow-up of these patients. FACS shows that symptomatic follow-up and clinical appointments add nothing to the detection of resectable recurrence. The main effect of monitoring was seen with a single CT scan at 12-18 months.

Dr. Tim Maughan is professor of clinical oncology at Oxford University and was the invited discussant of the paper at the meeting. He reported a consultant/advisory role with Sanofi and research funding from Merck Serono.