BackgroundPatients with stage II (T3 or T4, N0) or Dukes B colon cancer have a 5-year disease free survival rate of around 80% when all groups are combined, with minimal or no impact from adjuvant chemotherapy.
Overview of evidence (non-systematic literature review)
No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.
Controversy still exists regarding the role of standard adjuvant therapy for Stage II disease. The addition of oxaliplatin to fluorouracil does not appear to offer benefit in patients with stage II colon cancer.
Furthermore, the prognosis is often underestimated, with 5-year overall survivals of 87–90% for ‘high risk’ disease and 89–91% for ‘low/medium risk’ disease being reported in a recent clinical trial. Multiple clinical and pathologic factors define a subset of patients at increased risk of recurrence (including T4, perforation at presentation and inadequate node sampling) but whether these ‘high-risk’ patients benefit more from chemotherapy remains to be conclusively demonstrated.
Adjuvant chemotherapy for stage II cancers can be considered on a case-by-case basis but cannot be considered a standard of care.
|Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.|
The optimal approach to adjuvant therapy in stage II colon cancer remains uncertain. Adjuvant therapyA treatment given with or shortly after another treatment to make it more effective. This usually refers to surgery followed by chemotherapy or radiotherapy. can be considered in high-risk patients on a case-by-case basis.
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- Böckelman C, Engelmann BE, Kaprio T, Hansen TF, Glimelius B. Risk of recurrence in patients with colon cancer stage II and III: a systematic review and meta-analysis of recent literature. Acta Oncol 2015 Jan;54(1):5-16 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25430983.
- Yothers G, O'Connell MJ, Allegra CJ, Kuebler JP, Colangelo LH, Petrelli NJ, et al. Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses. J Clin Oncol 2011 Oct 1;29(28):3768-74 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21859995.
- Haller DG, Tabernero J, Maroun J, de Braud F, Price T, Van Cutsem E, et al. Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stage III colon cancer. J Clin Oncol 2011 Apr 10;29(11):1465-71 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21383294.