Abstract #2151: Intensified Follow-up in Colorectal Cancer Patients Using Frequent Carcino-Embryonic Antigen (CEA) Measurements and CEA-Triggered Imaging C. Verberne, P.M. Doornbos, I. Grossmann, G.H. De Bock, T. Wiggers
Background: The ultimate goal of post surgical follow-up is to identify relapsing patients as early as possible and to offer appropriate individuals the potential for curative salvage procedures. Advances in local therapy is leading to a change in the pattern of recurrences and the options for subsequent treatment. While guidelines exist to assist clinicians, the optimal strategy is unknown. CEA is an inexpensive, sensitive, valid and readily available test. The CEA Watch Trial describes an intensive follow-up protocol with the hypothesis that identification of the trend of rise rather than the absolute value of CEA may lead to earlier detection of relapsing patients.
Methods: Eleven hospitals in the Netherlands participated in this randmomized controlled multicenter prospective study using a stepped wedge cluster design. At prespecified time-points, hospitals changed from their usual follow-up care to an intensified schedule of CEA measurements every two months with a repeat at four weeks if the CEA value increased by 20%. Imaging was obtained if there was a further rise.
Results: 3223 patients were included in the analysis. There was a total of 243 recurrences detected during the study; 139 (57%) in the intensive follow-up group and 104 (43%) in the usual care group. Of these, 90 patients were able to be treated with curative intent. While the time to diagnosis did not differ between the groups, a significantly higher proportion in the intensive follow-up group were able to be offerred a potentially curative procedure (42 vs. 30%, p = 0.04).
Conclusions: The CEA watch protocol was more likely than standard care follow-up to detect recurrent disease at a stage treatable with curative intent.