Colon cancer: Clinical practice guidelines in oncology Journal Article
| Authors: | Benson, A. B. 3rd; Arnoletti, J. P.; Bekaii-Saab, T.; Chan, E.; Chen, Y. J.; Choti, M. A.; Cooper, H. S.; Dilawari, R. A.; Engstrom, P. F.; Enzinger, P. C.; Fleshman, J. W. Jr; Fuchs, C. S.; Grem, J. L.; Knol, J. A.; Leong, L. A.; Lin, E.; May, K. S.; Mulcahy, M. F.; Murphy, K.; Rohren, E.; Ryan, D. P.; Saltz, L.; Sharma, S.; Shibata, D.; Skibber, J. M.; Small, W. Jr; Sofocleous, C. T.; Venook, A. P.; Willett, C. |
| Article Title: | Colon cancer: Clinical practice guidelines in oncology |
| Abstract: | The panel believes that a multidisciplinary approach is necessary for managing colorectal cancer. The panel endorses the concept that treating patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection and adequate lymphadenectomy. Adequate pathologic assessment of the resected lymph nodes is important, with a goal of evaluating at least 12 nodes. Adjuvant therapy with FOLFOX (category 1, preferred), FLOX (category 1), CapeOx (category 1), 5-FU/LV (category 2A), or capecitabine (category 2A) is recommended by the panel for patients with stage III disease. Adjuvant therapy for patients with high-risk stage II disease is also an option; the panel recommends 5-FU/LV with or without oxaliplatin (FOLFOX or FLOX) or capecitabine with or without oxaliplatin (category 2A for all treatment options). Patients with metastatic disease in the liver or lung should be considered for surgical resection if they are candidates for surgery and if all original sites of disease are amenable to resection (R0) and/or ablation. Preoperative chemotherapy can be considered as initial therapy in patients with synchronous or metachronous resectable metastatic disease. When a response to chemotherapy would likely convert a patient from an unresectable to a resectable state (i.e., conversion therapy), this therapy should be initiated. Adjuvant chemotherapy should be considered after resection of liver or lung metastases. The recommended posttreatment surveillance program includes serial CEA determinations and periodic chest, abdominal, and pelvic CT scans, colonoscopic evaluations, and a survivorship plan to manage long-term side effects of treatment, facilitate disease prevention, and promote a healthy lifestyle. Recommendations for patients with disseminated metastatic disease represent a continuum of care in which lines of treatment are blurred rather than discrete. Principles to consider at initiation of therapy include preplanned strategies for altering therapy for patients in both the presence and absence of disease progression, including plans for adjusting therapy for patients who experience certain toxicities. Recommended initial therapy options for advanced or metastatic disease depend on whether the patient is appropriate for intensive therapy. The more-intensive initial therapy options include FOLFOX, FOLFIRI, CapeOx, and FOLFOXIRI (category 2B). Addition of a biologic agent (e.g., bevacizumab, cetuximab, panitumumab) is either recommended or listed as an option in combination with some of these regimens, depending on available data. Chemotherapy options for patients with progressive disease depend on the choice of initial therapy. © JNCCN-Journal of the National Comprehensive Cancer Network. |
| Keywords: | cancer survival; treatment outcome; survival rate; gene mutation; clinical feature; histopathology; neutropenia; review; cancer recurrence; hepatitis; bevacizumab; fluorouracil; cancer risk; diarrhea; drug dose reduction; drug efficacy; drug safety; drug withdrawal; monotherapy; side effect; skin toxicity; capecitabine; cancer adjuvant therapy; disease free survival; neoadjuvant therapy; cancer staging; drug megadose; neurotoxicity; nuclear magnetic resonance imaging; positron emission tomography; cancer diagnosis; neoplasm staging; laparoscopic surgery; colorectal cancer; adenocarcinoma; disease association; low drug dose; metastasis; computer assisted tomography; drug eruption; sensory neuropathy; bleeding; vomiting; dehydration; peripheral neuropathy; carcinoembryonic antigen; colonic neoplasms; genotype; nccn clinical practice guidelines; dexamethasone; practice guideline; continuous infusion; cetuximab; cancer mortality; risk assessment; irinotecan; panitumumab; colorectal carcinoma; febrile neutropenia; cause of death; drug fatality; survival time; liver metastasis; lung metastasis; drug surveillance program; add on therapy; colonoscopy; colorectal adenoma; stroke; folinic acid; colon cancer; adjuvant chemotherapy; vitamin d; genetic susceptibility; needle biopsy; brachytherapy; colon resection; liver resection; stent; contrast medium; colorectal surgery; fruit; vegetable; diet therapy; vitamin d deficiency; physical activity; neoplasm recurrence; inoperable cancer; external beam radiotherapy; blood cell count; oxaliplatin; fish; radiofrequency ablation; drug treatment failure; hand foot syndrome; floxuridine; 5-fluorouracil; anaphylaxis; digestive system perforation; peritoneum metastasis; fluoropyrimidine; polypectomy; colon polyp; retreatment; ablation therapy; hepatic artery; liver injury; chemoradiotherapy; lifestyle; venous thromboembolism; nccn guidelines; randomized controlled trial (topic); drug choice; clinical trial (topic); metastatic colorectal cancer; poultry; steatohepatitis; artery disease; crigler najjar syndrome; gilbert disease; healing impairment |
| Journal Title: | Journal of the National Comprehensive Cancer Network |
| Volume: | 9 |
| Issue: | 11 |
| ISSN: | 1540-1405 |
| Publisher: | Harborside Press |
| Date Published: | 2011-11-01 |
| Start Page: | 1238 |
| End Page: | 1289 |
| Language: | English |
| PROVIDER: | scopus |
| PUBMED: | 22056656 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 9 December 2011" - "Source: Scopus" |
