Adjuvant therapy for stage II colorectal cancer: Who and with what? Journal Article
| Authors: | Chung, K. Y. Y.; Kelsen, D. |
| Article Title: | Adjuvant therapy for stage II colorectal cancer: Who and with what? |
| Abstract: | The role of adjuvant chemotherapy for patients with stage II colon adenocarcinoma remains controversial. The high surgical cure rate for patients with "low-risk" stage II colon cancer, ranging from 75% to 80%, and the available clinical trials and meta-analyses provide conflicting recommendations for or against adjuvant chemotherapy for this group of patients. For fit "high-risk" stage II patients with clinical obstruction or perforation at presentation, in which the 5-year survival rate is 60% to 70%, there is little controversy, as these patients are routinely treated with adjuvant chemotherapy. Other potential high-risk factors, including high histologic grade, microsatellite stability, and loss of 18q, have yet to be validated in prospective trials. Patients with fewer than 12 regional lymph nodes identified in the surgical specimen have a statistically unclear risk of lymph node involvement. These patients may have stage III disease and should receive adjuvant therapy. The decision to use adjuvant chemotherapy to treat low-risk stage II colon cancer patients (no obstruction or perforation) should be an informed decision weighing the magnitude of a net 2% to 5% survival benefit, a 0.5% to 1.0% risk of mortality with chemotherapy in addition to 6 months of chemotherapy-related toxicities, other coexisting patient morbidities, and the anticipated life expectancy of each patient. As adjuvant chemotherapy is therapy addressing local or metastatic microscopic disease, and the effectiveness of systemic and biologically targeted therapy for advanced macroscopic colon cancer continues to improve rapidly, it remains to be determined by clinical trials whether therapies including newer agents such as cetuximab and bevacizumab administered in the adjuvant setting may affect survival for stage II cancer patients. Copyright © 2006 by Current Science Inc. |
| Keywords: | cancer survival; survival rate; clinical trial; neutropenia; paresthesia; review; bevacizumab; fluorouracil; cancer risk; diarrhea; drug potentiation; hypertension; side effect; systemic therapy; capecitabine; cancer adjuvant therapy; cancer patient; cancer staging; lymph node metastasis; cancer grading; colorectal cancer; medical decision making; drug eruption; bone marrow suppression; bleeding; mucosa inflammation; nausea; peripheral neuropathy; vincristine; cetuximab; cancer mortality; high risk patient; irinotecan; drug hypersensitivity; fever; malaise; thromboembolism; folinic acid; microsatellite instability; acne; comorbidity; warfarin; antihypertensive agent; colon perforation; weakness; headache; drug metabolism; intestine perforation; eye disease; biological therapy; oxaliplatin; hand foot syndrome; chromosome loss; life expectancy; fluoropyrimidine derivative; colon adenocarcinoma; abdominal cramp; atropine; respiratory tract disease; diaphoresis; chromosome 18q; levamisole; coronary artery spasm; colon obstruction; pharynx disease; semustine |
| Journal Title: | Current Treatment Options in Gastroenterology |
| Volume: | 9 |
| Issue: | 3 |
| ISSN: | 1092-8472 |
| Publisher: | Springer |
| Date Published: | 2006-06-01 |
| Start Page: | 272 |
| End Page: | 280 |
| Language: | English |
| DOI: | 10.1007/s11938-006-0046-z |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 2" - "Export Date: 4 June 2012" - "CODEN: CTOGA" - "Source: Scopus" |
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