Abstract
Abstract While randomized trials have proven the benefits of adjuvant therapy in node-positive colon cancer, the role of chemotherapy after curative resection of node-negative colon cancer is still debated. Individually, these trials have failed to conclusively demonstrate that 5-fluorouracil (5FU)-based chemotherapy significantly improves on the 80% 5-year survival of patients with stage II colon cancer. The debate has been further fueled by the publication of 2 conflicting meta-analyses: IMPACT B2 and the NSABP series. Based on their analysis of 5 adjuvant trials, the IMPACT investigators conclude that adjuvant therapy in stage II colon cancer is not routinely justified, whereas the pooled analysis of 4 trials by the NSABP recommends adjuvant therapy in this setting, citing similar proportional reductions in mortality for both stage II and stage III disease. Considered in total, current evidence does not support adjuvant therapy for all patients with stage II disease. However, the careful evaluation of node-negative patients for high-risk prognostic features may identify a cohort of patients for whom adjuvant therapy warrants consideration. Whenever available, patients with stage II colon cancer should continue to be encouraged to participate in clinical trials of adjuvant therapy. Copyright 2002, Elsevier Science (USA). All rights reserved.
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