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. 2020 Aug 20;20:790. doi: 10.1186/s12885-020-07252-y

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© The Author(s) 2020

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Schematic presentation of MEDOCC-CrEATE, using the trial within cohort (TwiCs) design. a PLCRC is a nationwide cohort study in the Netherlands with inclusion of CRC patients (all stages). By optional informed consent regarding collection of biomaterials and future randomization, observational as well as interventional trials can be performed within the cohort. b Non-metastatic CRC patients are included in MEDOCC when the patient signs informed consent for PLCRC including additional blood sampling. Blood samples are withdrawn before resection, 4–21 days after resection and every 6 months during the first 3 years of follow-up. c Eligible stage II colon cancer patients are randomized 1:1 following the TwiCs design. In the experimental group informed consent is being asked for immediate ctDNA analysis of the blood sample obtained after resection. If ctDNA is detectable, patients are offered adjuvant chemotherapy. The control group is not informed about MEDOCC-CrEATE and will receive standard of care