Abstract
Patients with stage 2 and stage 3 colon cancer often are treated with adjuvant chemotherapy. However, patients seen in daily practice have more comorbidity than those enrolled in clinical trials. This study aims to evaluate prognostic factors for recurrence and to ascertain the benefit of adjuvant chemotherapy on recurrence-free survival (RFS) of patients in a nonselected population. Furthermore, the impact of relative dose intensity (RDI) of adjuvant therapy on RFS is examined. Chart review was performed for 243 consecutive patients diagnosed and treated at a single center for stage 2 and stage 3 colon cancer from 2002 to 2008. Adjuvant chemotherapy was administered to 66 patients. Median overall survival (OS) was 5.84 years and median RFS was 5.37 years. For stage 2 disease, patients treated with or without adjuvant therapy had a median RFS of 5.49 and 5.73, respectively (p = ns). For stage 3 disease, median RFS rates were 5.08 and 1.19, respectively (p = 0.084). Overall RDI of oxaliplatin based chemotherapy higher than median was associated with increased RFS (p = 0.045). In conclusion, adjuvant therapy did not significantly increase recurrence-free survival. This could be the result of comorbidity in patients. Relative dose intensity of oxaliplatin based therapy is associated with RFS.
Highlights
Colorectal cancer is the third most occurring cancer with an incidence of 80.0 per 100.000 in the year 2011 in Netherlands
The relative dose intensity (RDI) for each drug was calculated by multiplying the time index, the time allotted for the administered chemotherapy cycles divided by the duration of said cycles, and the dose index, the administered cumulative dose divided by the standard cumulative dose. (For the regimens used as reference, see Appendix B [25, 26].)
One hundred forty-three patients were diagnosed with rectal cancer, 149 patients presented with stage 0, 1, or 4 colon cancer, and 78 patients were excluded for other reasons
Summary
Colorectal cancer is the third most occurring cancer with an incidence of 80.0 per 100.000 in the year 2011 in Netherlands. Curative therapy for colon cancer is largely determined by the lymph node status since positive lymph nodes provide an indication for adjuvant treatment with chemotherapy [3, 4]. A number of studies comparing treatment with fluorouracil/leucovorin (5FU/LV) and observation showed little to no added benefit [8,9,10]. Studies have been published showing benefit in treating patients with stage 2 disease with an increased risk of recurrence [11,12,13]. The presence of microsatellite instability (MSI) has been found to decrease the risk of recurrence and negate the effect of adjuvant chemotherapy on RFS in patients with stage 2 disease [14, 15]. Patients with MSI and stage 2 colon cancer have no indication for adjuvant therapy
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