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PulMiCC Trial

PulMiCC is a study of the effectiveness of Pulmonary Metastasectomy in Colorectal Cancer.

Metastases are deposits of cancer, in this case from a primary cancer in the colon or rectum, which are carried in the blood stream and become trapped in the capillary bed of another organ and grow there from microscopic clusters of cells to become visible on radiographic (X-ray) and magnetic resonance images.

Since the 1970s surgery to remove these metastases (that is secondary cancers) has been introduced and widely adopted. The most usual organs where the deposits occur and are amenable to surgical removal the liver and the lungs.

  • Liver metastases. There is a particular association between colon cancer and the liver. An important feature of the digestive system is that the blood carrying digested and absorbed nutrients is carried in the hepatic portal vein where perfuses the capillary bed of the liver transferring nutrients cancer cells may also be filtered out.
  • Lung metastases. All the blood of the body passes through the lungs to be oxygenated and as a result the lungs are the commonest site for metastases from cancers in general.

Surgery for their removal is carried out in the hope that this provides a second chance to catch and cure cancer that has escaped eradication by treatment of the primary in the colon.

The PulMiCC trial was funded by Cancer Research UK to recruit participants with colorectal cancer from 2010 to 2016. The protocols of the trial can be accessed here.

Publications from the PulMiCC trial investigators
  1. Treasure T: Surgical resection of pulmonary metastases. Eur J Cardiothorac Surg 2007;32:354-355.
  2. Treasure T: Surgery for lung metastases from colorectal cancer: the practice examined. Expert Review of Respiratory Medicine 2007;1:335-341.
  3. Treasure T: Pulmonary metastasectomy: a common practice based on weak evidence. Ann R Coll Surg Engl 2007;89:744-748.
  4. Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T: Pulmonary metastasectomy: the state of the practice in Europe.; 2007, p S182.
  5. Treasure T, Utley M, Hunt I: When professional opinion is not enough: surgical resection of pulmonary metastases. BMJ 2007;334:831-832.
  6. Utley M, Treasure T, Linklater K, Moller H: Better out than in?  The resection of pulmonary metastases from colorectal tumours.; in Xie X, Lorca F, Marcon E, (eds): Operations Research for Health Care Engineering: Proceedings of the 33rd International Conference on Operational Research Applied to Health Services. Saint-Etienne, Publications de l'Universitaire de Saint-Etienne, 2008, pp 493-500.
  7. Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T: Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008;3:1257-1266.
  8. Treasure T: Colorectal cancer: management of metastases. Surgical resection?; 2008, pp 1022-1023.
  9. Treasure T, Internullo E, Utley M: Resection of pulmonary metastases: a growth industry. Cancer Imaging 2008;8:121-124.
  10. Treasure T: Pulmonary metastasectomy for colorectal cancer: weak evidence and no randomised trials. Eur J Cardiothorac Surg 2008;33:300-302.
  11. Treasure T, Fallowfield L, Farewell V, Ferry D, Lees B, Leonard P, Macbeth F, Utley M: Pulmonary metastasectomy in colorectal cancer: time for a trial. Eur J Surg Oncol 2009;35:686-689.
  12. Fiorentino F, Hunt I, Teoh K, Treasure T, Utley M: Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis. J R Soc Med 2010;103:60-66.
  13. Primrose J, Treasure T, Fiorentino F: Lung metastasectomy in colorectal cancer: is this surgery effective in prolonging life? Respirology 2010;15:742-746.
  14. Pastorino U, Treasure T: A historical note on pulmonary metastasectomy. J Thorac Oncol 2010;5:S132-S133.
  15. Treasure T: Carcinoembryonic antigen: its place in decision making for pulmonary metastasectomy in colorectal cancer. J Thorac Oncol 2010;5:S179-S181.
  16. Fiorentino F, Treasure T: A plea for consistency in the reporting of surgical series illustrated with an analysis of 51 follow-up reports of pulmonary metastasectomy in colorectal carcinoma. J Thorac Oncol 2010;5:S192-S195.
  17. Treasure T, Fallowfield L, Lees B: Pulmonary metastasectomy in colorectal cancer: the PulMiCC trial. J Thorac Oncol 2010;5:S203-S206.
  18. Treasure, T: PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) trial; 2011, p 1010.
  19. Fiorentino F, Vasilakis C, Treasure T: Clinical reports of pulmonary metastasectomy for colorectal cancer: a citation network analysis. Br J Cancer 2011;104:1085-1097.
  20. Treasure T: PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) trial. Lung Cancer 2011;71:S44.
  21. Treasure T: Doubt and its resolution in mesothelioma, pulmonary metastases and lung cancer. Lung Cancer Management 2012;1:247-250.
  22. Treasure T, Lees B, Russell C: Pulmonary metastasectomy in colorectal cancer: recruitment in the PulMiCC trial; 2012, p 1130.
  23. Treasure T, Fiorentino F, Scarci M, Moller H, Utley M: Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2012;2:doi 10.1136 bmjopen-2012-00736.
  24. Treasure T: Oligometastatic cancer: an entity, a useful concept, or a therapeutic opportunity? J R Soc Med 2012;105:242-246.
  25. Russell RCG, Treasure T: Counting the cost of cancer surgery for advanced and metastatic disease. Br J Surg 2012;99:449-450.
  26. Treasure T, Fallowfield L, Lees B, Farewell V: Pulmonary metastasectomy in colorectal cancer: the PulMiCC trial. Thorax 2012;67:185-187.
  27. Treasure T, Milosevic M, Migliore M, Lees B: Pulmonary metastasectomy in colorectal cancer (PulMiCC International). Colorectal Cancer 2013;2:505-513.
  28. Fiorentino F, Treasure T: Pulmonary metastasectomy for colorectal cancer: Making the case for a randomized controlled trial in the zone of uncertainty. J Thorac Cardiovasc Surg 2013;146:748-752.
  29. Jegatheeswaran S, Satyadas T, Sheen AJ, Treasure T, Siriwardena AK: Thoracic surgical management of colorectal lung metastases: a questionnaire survey of members of the Society for Cardiothoracic Surgery in Great Britain and Ireland. Ann R Coll Surg Engl 2013;95:140-143.
  30. Treasure T, Leonard P: Pulmonary metastasectomy in colorectal cancer. Br J Surg 2013;100:1403-1404.
  31. Grunhagen D, Jones RP, Treasure T, Vasilakis C, Poston GJ: The history of adoption of hepatic resection for metastatic colorectal cancer: 1984-95. Crit Rev Oncol Hematol 2013;86:222-231.
  32. Treasure T, Moller H, Fiorentino F, Utley M: Forty years on: pulmonary metastasectomy for sarcoma. Eur J Cardiothorac Surg 2013;43:799-800.
  33. Embun R, Fiorentino F, Treasure T, Rivas JJ, Molins L: Pulmonary metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal metastasectomy registry (GECMP-CCR). BMJ Open 2013;3:5 e002787 doi:10.1136/bmjopen-2013-002787.
  34. Treasure T, Milosevic M, Fiorentino F: Pulmonary metastasectomy and the use of molecular and radiological markers: is this a way to reduce unavailing surgery? Eur J Cardiothorac Surg 2013.
  35. Migliore M, Lees B, Treasure T, Fallowfield LJ: Randomized Controlled Trial of Pulmonary Metastasectomy in Colorectal Cancer: PulMiCC International Is Open in Italy. Oncologist 2013;18:637.
  36. Treasure T, Utley M: Surgical removal of asymptomatic pulmonary metastases: time for better evidence. BMJ 2013;346:21-23.
  37. George R, Treasure T, Edwards J: Pulmonary metastasectomy in colorectal cancer: working towards a consensus. A survey of PuMiCC UK Trial Centre principle investigators and MDTs within a cancer network. Lung Cancer 2013;79:S67.
  38. Treasure T: Pulmonary metastasectomy in colorectal cancer (PulMiCC) - a surgeon friendly randomised trial. Lung Cancer 2013;79:S66-S67.
  39. Fiorentino F, Treasure T: Pulmonary metastasectomy: are observational studies sufficient evidence for effectiveness? Ann Thorac Surg 2013;96:1129-1131.
  40. Palma DA, Salama JK, Lo SS, Senan S, Treasure T, Govindan R, Weichselbaum R: The oligometastatic state - separating truth from wishful thinking. Nat Rev Clin Oncol 2014;11:549-557.
  41. Treasure T, Milosevic M, Fiorentino F, Macbeth F: Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 2014;69:946-949.
  42. Treasure T, Milosevic M, Fiorentino F, Pfannschmidt J: History and present status of pulmonary metastasectomy in colorectal cancer. World J Gastroenterol 2014;20:14517-14526.
  43. Treasure T: Pulmonary Metastasectomy for Colorectal Cancer: Recent Reports Prompt a Review of the Available Evidence. Curr Colorectal Cancer Rep 2014;10:296-302.
  44. Treasure T, Brew-Graves C, Fallowfield L, Farewell V, Golesworthy T, Leonard P, Monson K, Russell C: The need to determine whether lung metastasectomy improves survival in advanced colorectal cancer. BMJ 2014;348:g4085.
  45. Treasure T, Milosevic M, Fiorentino F: Pulmonary metastasectomy and the use of molecular and radiological markers: is this a way to reduce unavailing surgery? Eur J Cardiothorac Surg 2014;45:417-418.
  46. Macbeth F, Russell C, Treasure T: Cryotherapy for Lung Metastases: A Justifiable Procedure? J Thorac Oncol 2015;10:e120-e121.
  47. Fiorentino F, Treasure T: Pulmonary metastasectomy: a call for better data collection, presentation and analysis. Future Oncol 2015;11:19-23.
  48. Treasure T, Poston G: Debate: Surgical resection of colorectal metastases is [not] of proven benefit. http://www.surgeonsnews.com/features/debate-surgical-resection-of-colore...
  49. Treasure T, Russell C, Macbeth F: Re-launch of PulMiCC trial to discover the true effect of pulmonary metastasectomy on survival in advanced colorectal cancer. BMJ 2015;351:h6045.
  50. Macbeth F, Treasure T: Metastasectomy for Sarcoma. Clin Oncol (R Coll Radiol ) 2015;27:428-429.
  51. Macbeth F, Treasure T: Stereotactic Body Radiotherapy for Pulmonary Metastases. Clin Oncol (R Coll Radiol ) 2015;27:542-543.
  52. Treasure T, Brew-Graves C, Russell R, Macbeth F: PulMiCC trial (Pulmonary Metastasectomy in Colorectal Cancer); European Society of Coloproctology. 2015, p 103.
  53. Treasure T, Macbeth F: Doubt about effectiveness of lung metastasectomy for sarcoma. J Thorac Cardiovasc Surg 2015;149:93-94.
  54. Macbeth F, Treasure T: Pulmonary metastasectomy: where is the evidence? J Thorac Oncol 2015;10:e13-e14.
  55. Treasure T, Mineo T, Ambrogi V, Fiorentino F: Survival is higher after repeat lung metastasectomy than after a first metastasectomy: Too good to be true? J Thorac Cardiovasc Surg 2015;149:1249-1252.
  56. Macbeth F, Treasure T: Metastasectomy for Sarcoma. Clin Oncol (R Coll Radiol ) 2015.
  57. Treasure T, Macbeth F: Stereotactic Body Radiotherapy (SBRT) Is as Yet of Unproven Benefit for Patients With Lung Metastases. Am J Clin Oncol 2016;39:423-424.
  58. Aberg T, Treasure T: Analysis of pulmonary metastasis as an indication for operation: an evidence-based approach. Eur J Cardiothorac Surg 2016;50:792-798.
  59. Treasure T, Evans EM: Ethical considerations in putting metastasectomy for colorectal cancer to the 'fair test' of a randomised controlled trial: a sort-of Socratic Dialogue; 2016.
  60. Treasure T, Macbeth F: The GILDA trial finds no survival benefit from intensified screening after primary resection of colorectal cancer: the PulMiCC trial tests the survival benefit of pulmonary metastasectomy for detected asymptomatic lung metastases. Ann Oncol 2016;27:745.
  61. Treasure T, Macbeth F: Percutaneous Image Guided Thermal Ablation (IGTA) therapies are to be included in the interventional arm of the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial to test if survival and quality of life are better than with intention to treat without intervention. Eur J Surg Oncol 2016;42:435-436.
  62. Macbeth F, Russell C, Treasure T: Cryotherapy for Lung Metastases: A Procedure That Deserves Evaluation in a Randomized Trial. J Thorac Oncol 2016;11:e41.
  63. Macbeth F, Treasure T: Stereotactic Ablative Radiotherapy for 'Oligometastases': a Treatment in Search of Evidence. Clin Oncol (R Coll Radiol ) 2016.
  64. Treasure T: Pulmonary Metastasectomy in Colorectal Cancer: the PulMiCC trial (BTOG abstract); 2016, p S67-S68.
  65. Treasure T, Macbeth F: Is Surgery Warranted for Oligometastatic Disease? Thorac Surg Clin 2016;26:79-90.
  66. Treasure T, Williams NR: Best available evidence related to clinical benefit of surgical resection in multimodality treatment of metastatic colorectal cancer indicates that a randomised controlled trial is warranted. Eur J Cancer 2017;75:310-312.
  67. Aberg T, Treasure T: Lakartidningen 2017;114.
  68. Cardillo G, Treasure T: Recurrent Lung Metastases: Evidence of Benefit From Surgery Requires a Randomized Trial. Ann Thorac Surg 2017;104:1435.
  69. Macbeth F, Farewell V, Treasure T: RE: Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial. J Natl Cancer Inst 2017;109.
  70. Treasure T: Metastasectomy for colorectal cancer: are there clothes on the emperor? J R Soc Med 2017;110:227-230.
  71. Morris E, Treasure T: If a picture is worth a thousand words, take a good look at the picture: Survival after liver metastasectomy for colorectal cancer. Cancer Epidemiol 2017;49:152-155.
  72. Treasure T, Williams NR: Best available evidence related to clinical benefit of surgical resection in multimodality treatment of metastatic colorectal cancer indicates that a randomised controlled trial is warranted. Eur J Cancer 2017;75:310-312.
  73. Morris E, Treasure T: Surgical management and outcomes of colorectal cancer liver metastases. Cancer Epidemiol 2018;52:160-161.

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