Treasure, T;
Farewell, V;
Macbeth, F;
Batchelor, T;
Milosevic, M;
King, J;
Zheng, Y;
... PulMiCC investigators; + view all
(2021)
Pulmonary Metastasectomy in Colorectal Cancer burden of care study: analysis of local treatments for lung metastases and systemic chemotherapy in 220 patients in the PulMiCC cohort.
Colorectal Disease
10.1111/codi.15833.
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Treasure_The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) burden of care study_AOP.pdf - Published Version Download (1MB) | Preview |
Abstract
AIM: To examine the burden of further treatments in patients with colorectal cancer (CRC) following a decision about lung metastasectomy. METHODS: Five teams participating in the study of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) provided details on subsequent local treatments for lung metastases including the use of chemotherapy. For patients in three groups (no metastasectomy, one metastasectomy or multiple local interventions), baseline factors and selection criteria for additional treatments were examined. RESULTS: The five teams recruited 220 patients between October 2010 and January 2017. No lung metastasectomy was performed in 51 patients, 114 had one, and 55 patients had multiple local interventions. Selection for initial metastasectomy was associated with non-elevated CEA, fewer metastases, and no prior liver metastasectomy. These patients also had better ECOG scores and lung function at baseline. Four sites provided information on chemotherapy in 139 patients: 79 (57%) had 1-5 courses of chemotherapy, to a total of 179 courses. The patterns of survival after one or multiple metastasectomy interventions showed evidence of guarantee-time bias contributing to an impression of benefit over no metastasectomy. After repeated metastasectomy, a significantly higher risk of death was observed with no apparent reduction in chemotherapy usage. CONCLUSION: Repeated metastasectomy is associated with higher risk of death without reducing use of chemotherapy. Continued monitoring without surgery might reassure patients with indolent disease or allow response assessment during systemic treatment. Overall, the carefully collected information from the PulMICC study provides no indication of an important survival benefit from metastasectomy.
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