Abstract
Adjuvant chemotherapy has been established as the standard of care for patients with node-positive resected colon cancer. 5-fluorouracil modulated with leucovorin given for six months is currently the most widely accepted "standard" regimen. The role of adjuvant chemotherapy in stage II remain investigational and some prognostic indicators that correlate with higher risk for subsequent recurrence may be used for these patients when consider adjuvant chemotherapy. Other investigational approaches include regional portal vein infusion and intraperitoneal therapy, immunotherapy, and new drugs, with proven activity in metastatic disease. Patients older than 70 years are also candidate for adjuvant therapy of colorectal cancer. Adjuvant chemotherapy of rectal cancer is often associated with radiotherapy and enhances local control seen with radiotherapy and improves survival of these patients.
Highlights
In the management of resectable colon and rectal cancer, surgery is the primary modality, by which the bulk of the disease is removed
The single most important prognostic factor in anticipating the likelihood of residual disease is the stage of the disease: more than 90% patients in stage I will be cured by surgery only, but with stage II and III, the risk of microscopic residual or micrometastatic disease is substantially higher
The results showed that high-dose leucovorin was not superior to low-dose, and that levamisol had no benefit on survival and recurrence rate (6)
Summary
In the management of resectable colon and rectal cancer, surgery is the primary modality, by which the bulk of the disease is removed. In IMPACT meta-analysis on 1016 patients (9) in stage II, randomized for 5-FU-leucovorin or surgery alone, the absolute difference in long-time survival was 2% (83% vs 81%), giving borderline level of significance (p=0.05), and in pooled analysis of four NSABP trials (CO 1-4) the relative treatment benefits, in terms of hazard ratios (HRs) were largely the same for stage II and for stage III patients for both overall and disease-free survival (10). The results of confirmatory, phase III trial of 2761 patients with stage C colon cancer, randomized to receive 5-FU-leucovorin plus edrecolomab vs edrecolomab alone vs 5-FU-leucovorin were far less encouraging: 3-year survival rates of both 5-FU-containing arms were superior to that of the edrecolomab alone (17). They recommend future trials designed to evaluate separate regimens for intermediate vs. moderately high or high-risk patients (24)
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