Prevalence of Lung Metastases among 19,321 Metastatic Colorectal Cancer Patients in Eight Countries of Europe and Asia

Jördens, Markus S.; Labuhn, Simon; Luedde, Tom; Hoyer, Laura; Kostev, Karel; Loosen, Sven H.; Roderburg, Christoph

doi:10.3390/curroncol28060423

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…There is limited biologic rationale suggesting that colon cancer has a predilection for the lungs. 33 Observational data suggesting benefit from lung metastasectomy 25 may also underestimate the potential harms resulting from decreased lung capacity and lung function. 34 In a rare contemporary randomized trial comparing lung resection versus chemotherapy, 5-year OS was 29% in the control group, with no significant improvement in 5-year OS among those receiving lung resection, 35 albeit the sample size was small and the trial was terminated early because of slow recruitment.…”

Section: Colon Cancermentioning

confidence: 99%

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Wilson,

Wright,

Koven

et al. 2024

JCO

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Every year, millions of patients globally are diagnosed with early-stage cancer and treated with curative intent. After treatment, patients are clinically followed for treatment toxicity and may undergo surveillance imaging to monitor for disease recurrence. The goal of post-treatment surveillance should be to improve patient overall survival (OS) and/or quality of life (QOL). Although there is value in monitoring for short-and longer-term treatment toxicity, a frequently stated goal is to identify early recurrence allowing early treatment to improve outcomes. However, for most tumors, there is no evidence to suggest that early diagnosis and treatment of recurrent asymptomatic disease improves OS or QOL. Moreover, surveillance scans may provoke anxiety and exacerbate fear of recurrence, 1-3 expose patients to further investigations for incidental findings, and cause under-recognized time toxicities and financial opportunity costs for patients and health systems.For patients who do undergo routine imaging surveillance (most often with computed tomography [CT]), there are three potential outcomes: (1) the CT scan is clear, providing shortterm reassurance; (2) the CT shows recurrence leading to complex discussions regarding early treatment versus observation in the absence of symptoms; and (3) there is an incidental finding leading to additional imaging and investigations (Table 1). Edelman et al 4 have proposed principles for evaluating follow-up investigations after curative-intent therapy: (1) the screening interval and duration of testing should be consistent with the maximal risk of recurrence and natural history of the tumor; (2) risk of second malignancies should guide tests;(3) tests should have high positive and negative predictive values; (4) therapy should be available that will result in cure, significant prolongation of life, or palliation of symptoms; and (5) initiation of earlier therapy should improve outcome. Unfortunately, for most tumor types, surveillance imaging after curative intent resection does not fulfill criteria 4 and 5.We are concerned that the risk-benefit ratio of routine surveillance imaging is not adequately considered by many practice guidelines, nor is it routinely discussed with patients. In this commentary, we review surveillance imaging recommendations after curative-intent treatment from international, regional, and country-specific guidelines (including ASCO, European Society of Medical Oncology [ESMO], National Comprehensive Cancer Network [NCCN], Cancer Care Ontario [CCO], and National Cancer Grid of India [NCGI]). We start with breast and colon cancer where recommendations are based on some evidence. We contrast this with other common solid tumors-pancreatic, lung, and gastric cancers-where there is limited supporting randomized evidence. Although previous papers have discussed surveillance imaging guidelines for individual cancers, [5][6][7][8][9] there is value to cross-tumor comparisons to understand variations in practice across our discipline and to learn from alternat...

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Section: Colon Cancermentioning

confidence: 99%

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Wilson,

Wright,

Koven

et al. 2024

JCO

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“…Therefore, the liver is one of the main sites for metastasis [5]. Venous drainage for the lower 1/3 of the rectum drains via the inferior rectal vein into the systemic circulation, thereby leading to metastasis to the lungs [6].…”

Section: Introductionmentioning

confidence: 99%

The Importance of Digital Rectal Examination in Identifying Early-Onset Rectal Malignancies

Ramanathan,

Smith

2024

Cureus

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Colorectal cancer (CRC) is the second most diagnosed cancer and the second leading cause of cancer-related deaths in the United States. Rectal cancers, specifically, are the second most common cancer of the large intestine. Although once perceived as a disease of the elderly, the incidence of early-onset CRC (EO-CRC), classified as occurring in individuals less than 50 years old, has been paradoxically increasing. Although the incidence of rectal cancers has increased, the digital rectal exam (DRE) continues to be an underutilized physical exam maneuver when a patient presents with red-flag symptoms. Here, we present a case of a 38year-old male from West Virginia who was referred to general surgery for complaints of rectal bleeding attributed to internal hemorrhoids. After undergoing a colonoscopy, the patient was found to have a rectal mass consistent with adenocarcinoma. We describe the importance of identifying red-flag signs to keep colorectal malignancy in the differential diagnosis in a young patient and highlight the importance of performing rectal exams to identify rectal cancers early to expedite treatment.

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“…[1,2] Among these patients, pulmonary metastasis (PM) accounts account for more than half of patient population in the single and all-site metastasis according the study by Ding et al [1] There are several factors associated with the increased risk of PM of CRC, including tumor staging, lower tumor location, and presence of lymphovascular invasion or perineural invasion. [1,2] Watanabe et al [3] found that the 5-year PM rate after primary tumor R0 resection increased significantly according to initial stage, from 0.6% in stage I, 2.2% in stage II, 9.8% in stage III, to 24.6% in stage IV CRC. Computed tomography (CT) imaging study remains as the primary detection tool for pulmonary metastasis.…”

mentioning

confidence: 99%

A review of surgery for lung metastasis from colorectal cancer

et al. 2023

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Lung is one of the most vulnerable organs for distant metastasis from colorectal cancer (CRC) with a mean survival time of 5 to 19 months in literature. For selected cases of lung metastasis from CRC, aggressive treatment can provide long-term survival benefit to the patients among which surgery can provide a significant better survival benefit than other treatment modalities. However, multimodality treatment approaches can provide further improvement for the clinical outcome. The advancement of minimally invasive surgery for the pulmonary diseases has offered the patients an effective treatment option for tumor eradication while a fast course of postoperative recovery. In the article, we reviewed the current status of treatment for pulmonary metastasis from CRC as well as the experience in the National Taiwan University Hospital.

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Prevalence of Lung Metastases among 19,321 Metastatic Colorectal Cancer Patients in Eight Countries of Europe and Asia

Cited by 6 publications

References 20 publications

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

The Importance of Digital Rectal Examination in Identifying Early-Onset Rectal Malignancies

A review of surgery for lung metastasis from colorectal cancer

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