Role of surveillance imaging and endoscopy in colorectal cancer follow-up: Quality over quantity?

Table 2 Summary of recent randomized control trials evaluating intensive vs less intensive surveillance strategies

Trial	Setting	Enrollment period	Patient population	Intensive group	Control group	Results
FACS (JAMA 2014)[23]	United Kingdom	2003-2009	1201 stage I-III	Either: CEA every 3 mo for 2 yr, then every 6 mo for 3 yr, with a single chest, abdomen, and pelvis CT scan at 12-18 mo if requested; CT of the chest, abdomen, and pelvis every 6 mo for 2 yr, then annually for 3 yr; Both blood CEA measurement and CT imaging as above	No scheduled follow-up except a single CT scan of the chest, abdomen, and pelvis at 12-18 mo if requested	No difference in overall mortality for combined CEA and CT compared to minimal follow-up
GILDA (Ann Oncol 2016)[22]	Italy	1998-2006	1228 Dukes B2-C (high risk stage II and III)	Office visit, blood tests (CEA, CBC, liver tests, CA19-9) every 4 mo for 2 yr, then every 6 months for 2 yr then at 5 yr; Colonoscopy and chest X-ray every year for 5 yr; Liver ultrasound at 4, 8, 12, 16, 24, 36, 48, and 60 mo	Office visit, CEA, every 4 mo for 2 yr, then every 6 mo for 2 yr then at 5 yr; Colonoscopy at 1 yr and at 4 yr; Liver ultrasound at 8 and 20 mo	No difference in overall survival or health-related quality of life scores
COLFOL (JAMA 2018)[11]	24 centers in Sweden, Denmark, and Uruguay	2006-2010	2509 stage II and III	CEA and CT thorax/abdomen at 6, 12, 18, 24, and 36 mo	CEA and CT thorax/abdomen at 12 mo and 36 mo	No difference in overall mortality, cancer-specific mortality, and cancer recurrence
PRODIGE-13[24]	96 centers in France and Belgium	2009-2015	1997 stage II and III	Clinical assessments every 3 mo until year 3 and every 6 mo until year 5, then at least yearly thereafter; Alternating assessments every 3 mo of CT thorax/abdomen/pelvis or abdominal ultrasound until year 3 and then every 6 mo until year 5; Colonoscopy at 3 yr after surgery then every 3 to 6 yr thereafter	Clinical assessments every 3 mo until year 3 and every 6 mo until year 5, then at least yearly thereafter; Abdominal ultrasound every 3 mo until year 3 and then every 6 mo until year 5; chest X-ray every; 6 mo until year 3 and then annually until year 5; Colonoscopy at 3 yr after surgery then every 3 to 6 yr thereafter	Pending for 2021

CEA: Carcinoembryonic antigen; CT: Computed tomography.