Intended for healthcare professionals

Letters Colorectal cancer: a cautionary tale

The need to determine whether lung metastasectomy improves survival in advanced colorectal cancer

BMJ 2014; 348 doi: (Published 18 June 2014) Cite this as: BMJ 2014;348:g4085
  1. Tom Treasure, surgeon and chief investigator PulMiCC trial1,
  2. Chris Brew-Graves, deputy director (operations)2,
  3. Lesley Fallowfield, professor of psycho-oncology3,
  4. Vern Farewell, senior statistician4,
  5. Tal Golesworthy, engineer and public and patient representative for PulMiCC5,
  6. Pauline Leonard, lead cancer clinician and consultant medical oncologist6,
  7. Kathryn Monson, quality of life researcher, senior trials coordinator/manager3,
  8. Christopher Russell, surgeon and chair of PulMiCC trial steering committee7
  1. 1Clinical Operational Research Unit, UCL, London WC1H 0BT, UK
  2. 2UCL Clinical Trials Group (PuLMiCC coordinating centre), London, UK
  3. 3Sussex Health Outcomes, Research & Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
  4. 4MRC Biostatistics Unit, Cambridge, UK
  5. 5Tewkesbury, UK
  6. 6Whittington Hospital, London, UK
  7. 7UCL, London, UK
  1. tom.treasure{at}

Godlee highlights evidence that ought to lead to a more measured and evidence based approach to the management of advanced colorectal cancer.1 The current approach may be an example of well intended action that does not deliver the expected health benefits.

Current recommended NHS practice in patients with metastatic cancer in the liver or lungs, or both, is to monitor intensively by measuring the tumour marker carcinoembryonic antigen in the blood and screening regularly with computed tomography.2 Suspicion of recurrence is followed by further investigation, with the intention of surgically removing recurrent disease. The FACS trial, …

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