Four hundred patients with resectable colon and rectal cancers were operated on by 37 surgeons at 31 institutions. Patients were monitored with carcinoembryonic antigen (CEA) level determinations and clinical examinations. One hundred thirty patients had recurrences, and 75 were reoperated on, with 43 reoperations CEA‐directed and 32 clinically directed. Two of 75 died within 1 month after the second operation. Twenty‐two second‐look patients remain free of disease 5 years after their second operaton. The highest resectability of recurrent cancer occurred in patients with a CEA level below 11 ng/ml in whom the CEA level was determined at intervals of 1 to 2 months. Cancer 55:1284‐1290, 1985.

Objective To determine the correlation between tumour response to preoperative RCTX and lymph node status, an established parameter of clinical outcome.Method After IRB approval, 86 consecutive rectal cancer patients who received preoperative RCTX were identified. Fifty seven were males. Mean age 62 years. Preoperative staging by ultrasound was available in 60 patients. Radiotherapy consisted of (40-60 g) and chemotherapy of 5-FU infusion (1500 mg ⁄ m 2 week), assessed using Dworak's system. N2). Response to RCTX was significantly associated with node stage, hence individuals without node involvement (N0) had 66% of positive tumour response (TRG 4), while individuals with node metastasis had less response to RCTX (TRG 0, 1 and 2) 35% N1 and 14% for N2 (P = 0.007). Node status was independently associated to poor response to preoperative RCTX, even after adjusting for tumour stage, age and gender (OR 0.02, 95% CI 0.0009-0.67).Conclusion Tumour shrinkage by preoperative RCTX appears to correlate with lymph node metastasis suggesting that neoadjuvant RCTX may have a positive impact in overall patient survival.

Eighty-seven patients with recurrent breast cancer after mastectomy were analyzed for patterns of recurrence and methods of detection. After an average disease-free interval of 30 months, 38% developed osseous metastases, 16% recurred locally, 10% had local plus systemic disease, 10% showed pulmonary metastases and the remainder were distributed among liver, brain, and remaining breast disease. In 79 patients recurrence was heralded by symptoms. Physical examination in five asymptomatic patients revealed local or supraclavicular recurrence. In only three asymptomatic patients was recurrence documented by "routine" chest x-rays (in two), or liver enzymes/liver scan (in one). No asymptomatic disease was found by bone scan. It is concluded that periodic history, physical examination, and chest x-rays are the most important components in the follow-up of breast cancer patients. Radioisotope scans and other radiographs are valuable in confirming symptomatic disease and detecting additional diseases, but cannot be recommended routinely in the asymptomatic patient because of low yield and cost.