Colorectal Cancer: Postoperative Adjuvant Therapy
Postoperative adjuvant chemotherapy improves survival and reduces the rate of recurrence for patients with stage III colon cancer and may also improve survival in some subgroups of patients with stage II colon cancer. The recommended chemotherapeutic regi
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Key Concepts • Patients with stage III colon cancer should be considered for adjuvant chemotherapy. • Oxaliplatin-based adjuvant chemotherapy regimens improve survival of stage III colon cancer patients by an absolute 20–25 % at 5 years versus no chemotherapy. • Adjuvant chemotherapy has not been demonstrated to have significant impact on survival for stage II colon cancer patients, but it can be considered for patients whose tumors have high-risk features. • In colon cancer patients, radiotherapy should be considered when tumors penetrate other fixed structures (T4) and can be guided by placing surgical clips at the time of operation. • Patients with clinical stage II and III rectal cancers who undergo neoadjuvant chemoradiotherapy should be considered for postoperative adjuvant chemotherapy, regardless of the final pathologic staging, although the efficacy of adjuvant chemotherapy in this setting has not been firmly established. While surgery remains the primary treatment for patients with colon and rectal cancer, adjuvant treatment with chemotherapy and radiotherapy plays an increasingly important role. For patients with stage III colon cancer, adjuvant chemotherapy has been recommended since 1990 [1]. More recently the National Quality Forum has endorsed metrics related to the administration of chemotherapy in stage III colon cancer patients in order to ensure that patients with stage III colon cancer not only are considered for chemotherapy but are given chemotherapy in a timely fashion [2]. For patients with stage I colon cancer, surgery alone is highly successful, and thus no adjuvant therapy is currently recommended. On the other hand, patients with stage II colon cancer may benefit from adjuvant treatment, although this is controversial and remains the focus of clinical trials. Finally, stage IV colon cancer patients are usually primarily treated with chemotherapy— this is the subject of a later chapter (see Chap. 36).
For patients with rectal cancer, adjuvant treatment has been recommended for both stage II and stage III disease. This treatment involves both chemotherapy and radiotherapy and usually begins preoperatively (see Chap. 28). After surgery, clinical stage II and stage III rectal cancer patients are recommend to undergo adjuvant postoperative chemotherapy regardless of the final surgical pathology. As with stage I colon cancer, surgery alone is highly successful for patients with stage I rectal cancer. This chapter will present the current recommendations regarding the use of postoperative adjuvant therapy for stage II and stage III colon and rectal cancer.
Colon Cancer Stage III Colon Cancer Adjuvant chemotherapy is recommended for all stage III colon cancer patients because it decreases recurrence and increases survival when compared to surgery alone [3, 4]. After surgery alone for stage III colon cancer, overall 5-year survival is 40–60 % [5]. Current chemotherapeutic regimens improve overall survival to 70–80 % [6]. Thus, 5-year overall survival of stage III colon cancer patients improves
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