More frequent chest imaging may benefit certain colorectal cancer patients

More frequent chest imaging may benefit certain colorectal cancer patients

Colorectal cancer patients with certain clinical features may benefit from more frequent chest imaging to identify and target cancer that has spread to the lungs, according to a new study presented at the American College of Surgeons (ACS) Clinical Congress 2022 Scientific Forum. The findings have the potential to improve the long-term outcomes of patients with to improve metastatic colon cancer.

Despite improved survival rates, colorectal cancer remains the third leading cause of cancer-related death in the United States. Although colorectal cancer rates have declined in people age 65 and older, largely thanks to increased screening efforts, rates are increasing in younger adults. If the cancer is caught early, many patients can remain disease-free for the rest of their lives after surgical treatment, but colorectal cancer can spread (metastasize) in up to 50% of patients. One of the most common areas where colon cancer spreads is the lungs, affecting up to 18% of colon cancer patients. Early detection of cancer nodules in the lungs provides patients with the best outcomes, but there are no evidence-based standards for when and how often colorectal cancer patients should be screened with chest CT or PET scans.

“After patients are diagnosed with colorectal cancer, many of them want to better understand what their cancer diagnosis entails in terms of their monitoring and survival for the rest of their lives, but we currently lack data and consistent guidelines to support how often these patients should be treated.” with breast imaging," said co-author Mara Antonoff, MD, FACS, associate professor of thoracic and cardiovascular surgery, UT MD Anderson Cancer Center, Houston, where she also serves as program director for education. "With this study, we sought to develop an evidence-based strategy to determine how often, at what intervals, and for how long patients with “If you are at risk of developing lung metastases, you should undergo chest imaging.”

Dr. Antonoff specializes in thoracic surgical oncology and has a clinical interest in colorectal cancer that has spread to the lungs. She is leading a multi-institutional study under the auspices of the Thoracic Surgery Oncology Group (TSOG) (TSOG 103) of the American Association for Thoracic Surgery (AATS) to develop optimal treatment strategies for patients with colorectal cancer whose cancer spread is limited to the lung.

To find out which colorectal cancer patients could benefit from early chest imaging and at what intervals, Drs. Antonoff and an interdisciplinary team of researchers at MD Anderson – including cardiothoracic surgeons, colorectal cancer surgeons and gastrointestinal oncologists – collaborated on this research project to explore evidence-based surveillance guidelines for colorectal patients at risk of developing lung metastases.

Study details

Using two MD Anderson cancer databases that included both patients with colorectal cancer and patients with breast cancer, the study team retrospectively reviewed data from patients with colorectal cancer who did and did not develop lung metastases. Patients were divided into groups according to the development of lung metastases and the time of their diagnosis. Using statistical methods, the team examined which clinical characteristics, such as age or genetic factors, correlated most strongly with the risk of developing lung metastases.

Key findings

• Of 1,600 patients with colorectal cancer, 233 (14.6%) developed lung metastases, with a median time of 15.4 months after colorectal surgery.

• The team identified age, neoadjuvant or adjuvant systemic therapy (such as chemotherapy or immunotherapy), lymph node ratio, lymphovascular and perineural invasion (high-risk tumor features observed under the microscope), and the presence of KRAS genetic mutations as risk factors for developing lung metastases.

• Further data analysis found that patients who required systemic therapy at the time of their surgery for colorectal cancer, had increased lymph node density, and a KRAS mutation were at risk of developing lung metastases within three months of surgery.

• The authors concluded that these patients may benefit from more frequent monitoring with chest CT or PET scans.

Nathaniel Deboever, MD, a general surgery resident at UTHealth Houston McGovern Medical School and lead author of the study, noted that while these risk factors are not necessarily surprising from a clinical perspective, they highlight the need to appropriately evaluate certain colorectal cancer patients after surgical treatment. In some cases, early surgical removal of cancerous lung nodules can significantly improve outcomes.

“A concrete clinical application of this research, once validated, is to establish evidence-based guidelines for chest surveillance in patients with resected colorectal cancer,” said Dr. Deboever, who completed this research as part of his research fellowship in the Department of Thoracic Surgery and Cardiovascular Surgery at MD Anderson. “These guidelines will hopefully allow high-risk patients to undergo timely X-ray screening, enabling early diagnosis of lung disease.”

Next Steps

In future research, the team plans to validate the results in a separate group of patients in hopes of formalizing breast monitoring protocols for widespread clinical use. Dr. Antonoff and Dr. Deboever noted that as colorectal cancer research advances, sensitive blood tests to detect cancer or advanced radiological screening methods using artificial intelligence could also play an important role in monitoring patients.

Many patients receive cancer treatment outside of cancer hospitals. Therefore, algorithms, pathways, and recommended protocols can be very helpful for providers caring for many different diseases with rapidly changing recommendations. I think this research is really just the tip of the iceberg.”

Mara Antonoff, MD, FACS, associate professor of thoracic and cardiovascular surgery, UT MD Anderson Cancer Center, Houston

This study was funded by the Department of Thoracic and Cardiovascular Surgery at MD Anderson Cancer Center, including financial support from the Mason Family Philanthropic Research Fund.

Study co-authors are Erin M. Bayley, MD, MS; Brian K. Bednarski, MD, FACS; and Van Morris, MD.

Source:

American College of Surgeons

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