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American Society Of Clinical Oncology Recommendations On Adjuvant Chemotherapy For Stage II Colon Cancer.

A. Benson, D. Schrag, M. Somerfield, A. Cohen, A. Figueredo, P. Flynn, M. Krzyzanowska, J. Maroun, P. McAllister, E. Van Cutsem, M. Brouwers, M. Charette, D. Haller
Published 2004 · Medicine

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PURPOSE To address whether all medically fit patients with curatively resected stage II colon cancer should be offered adjuvant chemotherapy as part of routine clinical practice, to identify patients with poor prognosis characteristics, and to describe strategies for oncologists to use to discuss adjuvant chemotherapy in practice. METHODS An American Society of Clinical Oncology Panel, in collaboration with the Cancer Care Ontario Practice Guideline Initiative, reviewed pertinent information from the literature through May 2003. RESULTS A literature-based meta-analysis found no evidence of a statistically significant survival benefit of adjuvant chemotherapy for stage II patients. Recommendations The routine use of adjuvant chemotherapy for medically fit patients with stage II colon cancer is not recommended. However, there are populations of patients with stage II disease that could be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology. CONCLUSION Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer. Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease. The ultimate clinical decision should be based on discussions with the patient about the nature of the evidence supporting treatment, the anticipated morbidity of treatment, the presence of high-risk prognostic features on individual prognosis, and patient preferences. Patients with stage II disease should be encouraged to participate in randomized trials.
This paper references
10.7326/0003-4819-122-5-199503010-00001
Fluorouracil plus Levamisole as Effective Adjuvant Therapy after Resection of Stage III Colon Carcinoma: A Final Report
C. Moertel (1995)
10.1056/NEJMOA022289
Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer.
C. Ribic (2003)
10.1200/JCO.1988.6.6.947
Adjuvant therapy in large bowel adenocarcinoma: long-term results of a Southwest Oncology Group Study.
F. Panettiere (1988)
10.1093/JNCI/89.7.497
Portal vein chemotherapy for colorectal cancer: a meta-analysis of 4000 patients in 10 studies. Liver Infusion Meta-analysis Group.
R. Gray (1997)
10.1007/BF02237397
Prognostic factors in colorectal cancer
C. Ratto (1998)
10.1186/1471-2407-1-9
Potential role and chronology of abnormal expression of the Deleted in Colon Cancer (DCC) and the p53 proteins in the development of gastric cancer
F. Graziano (2001)
10.1200/JCO.2003.06.025
Adjuvant chemotherapy for breast cancer: how presentation of recurrence risk influences decision-making.
C. Chao (2003)
10.1200/JCO.1989.7.10.1447
Surgical adjuvant therapy of large-bowel carcinoma: an evaluation of levamisole and the combination of levamisole and fluorouracil. The North Central Cancer Treatment Group and the Mayo Clinic.
J. A. Laurie (1989)
10.1056/NEJM200009283431302
Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group.
L. Saltz (2000)
10.1043/0003-9985(2000)124<0979:PFICC>2.0.CO;2
Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999.
C. Compton (2000)
10.1200/JCO.2004.03.087
Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care's gastrointestinal cancer disease site group.
A. Figueredo (2004)
10.1200/JCO.1998.16.1.295
Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer.
M. O'connell (1998)
10.1200/JCO.2002.11.084
Adjuvant chemotherapy use for Medicare beneficiaries with stage II colon cancer.
D. Schrag (2002)
10.1200/JCO.2001.19.18.3801
Mortality associated with irinotecan plus bolus fluorouracil/leucovorin: summary findings of an independent panel.
M. Rothenberg (2001)
10.1200/JCO.2003.08.998
Is relative risk reduction a useful measure for patients or families who must choose a method of treatment?
H. S. Wieand (2003)
10.1245/ASO.2003.03.058
The Prognosis of T3N0 Colon Cancer Is Dependent on the Number of Lymph Nodes Examined
R. Swanson (2003)
Adjuvant therapy for stage III colon cancer after complete resection. Provincial Gastrointestinal Disease Site Group.
A. Figueredo (1997)
10.1200/JCO.1995.13.12.2936
Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes' B2 colon cancer.
C. Moertel (1995)
AJCC Cancer Staging Manual. 6th ed
F. Greene (2002)
10.1200/JCO.2003.09.074
Communicating the value of adjuvant chemotherapy.
G. Sonpavde (2003)
10.1200/JCO.1990.8.9.1466
Adjuvant therapy of Dukes' A, B, and C adenocarcinoma of the colon with portal-vein fluorouracil hepatic infusion: preliminary results of National Surgical Adjuvant Breast and Bowel Project Protocol C-02.
N. Wolmark (1990)
10.1007/978-1-4757-3656-4
AJCC Cancer Staging Manual
M. B. Amin (2002)
10.1200/JCO.2004.09.059
Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much?
S. Gill (2004)
10.1200/JCO.1998.16.2.515
Survey of breast cancer patients concerning their knowledge and expectations of adjuvant therapy.
P. Ravdin (1998)
10.1016/0140-6736(92)91708-G
Randomised controlled trial of adjuvant chemotherapy by portal-vein perfusion after curative resection for colorectal adenocarcinoma
L. Fielding (1992)
10.1056/NEJMOA010957
A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients.
D. Sargent (2001)
10.1016/S0093-7754(01)90247-7
Should Dukes' B patients receive adjuvant therapy? A statistical perspective.
M. Buyse (2001)
10.1016/S0140-6736(00)02034-1
Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial
J-Y. Douillard (2000)
10.1200/JCO.2000.18.16.2938
Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer.
A. de Gramont (2000)
10.1200/JCO.2001.19.4.972
Understanding the utility of adjuvant systemic therapy for primary breast cancer.
C. Loprinzi (2001)
10.1056/NEJM199002083220602
Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma.
C. Moertel (1990)
10.1093/JNCI/80.1.30
Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01.
N. Wolmark (1988)
10.1097/00000658-200210000-00003
A New TNM Staging Strategy for Node-Positive (Stage III) Colon Cancer: An Analysis of 50,042 Patients
F. Greene (2002)
10.1097/01.MP.0000062859.46942.93
Colorectal Carcinoma: Diagnostic, Prognostic, and Molecular Features
C. Compton (2003)
10.1054/bjoc.2001.2117
Adjuvant 5FU plus levamisole in colonic or rectal cancer: improved survival in stage II and III
B. Taal (2001)
10.1200/jco.1999.17.5.1356
Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators.
C. Erlichman (1999)
10.1200/JCO.2003.05.062
Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089.
T. L. Le Voyer (2003)
10.1001/ARCHSURG.1990.01410190095015
Adjuvant therapy for resectable colorectal carcinoma with fluorouracil administered by portal vein infusion. A study of the Mayo Clinic and the North Central Cancer Treatment Group.
R. Beart (1990)
10.1002/BJS.1800720509
A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer
I. Taylor (1985)



This paper is referenced by
10.1097/SLA.0b013e3182369101
Prediction of Prognosis Is Not Improved by the Seventh and Latest Edition of the TNM Classification for Colorectal Cancer in a Single-Center Collective
U. Nitsche (2011)
10.1002/cam4.737
A new simple morphology‐based risk score is prognostic in stage I/II colon cancers
B. Märkl (2016)
10.1016/j.jamcollsurg.2013.12.046
Changes in colorectal cancer care in japan before and after guideline publication: a nationwide survey about D3 lymph node dissection and adjuvant chemotherapy.
M. Ishiguro (2014)
Systematic evaluation of the clinical effects of supportive mistletoe treatment within chemo- and/or radiotherapy protocols and long-term mistletoe application in nonmetastatic colorectal carcinoma: multicenter, controlled, observational cohort study.
W. E. Friedel (2009)
Indication and efficacy of adjuvant chemotherapy with oral fluoropyrimidines for dukes' B colorectal cancer.
K. Yoshimatsu (2006)
10.1093/ANNONC/MDL029
Adjuvant therapy in colon cancer--what, when and how?
I. Chau (2006)
10.1097/SLA.0b013e31827c1180
Independent Validation of a Prognostic Genomic Signature (ColoPrint) for Patients With Stage II Colon Cancer
M. Maak (2013)
10.3816/CCC.2010.n.002
Is tailored adjuvant treatment for colon cancer possible?
M. Eynde (2010)
Use of molecular biomarkers to inform adjuvant therapy for colon cancer.
Niharika B Mettu (2013)
10.1038/sj.bjc.6603348
Cost-effectiveness of oxaliplatin and capecitabine in the adjuvant treatment of stage III colon cancer
S. Eggington (2006)
10.1002/jso.25355
Improved survival in rectal cancer patients who are treated with long‐course versus short‐course neoadjuvant radiotherapy: A propensity‐matched analysis of the NCDB
B. Chapman (2019)
10.3389/fonc.2014.00029
The Tumor Border Configuration of Colorectal Cancer as a Histomorphological Prognostic Indicator
V. Koelzer (2014)
10.1002/cncr.26245
Adjuvant chemotherapy improves survival in patients with American Joint Committee on Cancer stage II colon cancer
S. McKenzie (2011)
10.1016/j.bbcan.2008.12.002
Apoptosis signaling proteins as prognostic biomarkers in colorectal cancer: a review.
Suzanne M Hector (2009)
10.1007/s00432-017-2512-5
Karyopherin α-2 is a reliable marker for identification of patients with high-risk stage II colorectal cancer
Dongjun Jeong (2017)
10.5430/JST.V1N3P87
Tumor infiltrating immune cells - potential powerful predictors in colorectal cancer patients
S. Riss (2011)
Model Selection Methods for Cancer Staging and Other Disease Stratification Problems
Yunzhi Lin (2012)
Prognostic factors in colon cancer
O. Sjo (2012)
10.1093/annonc/mdr062
Prognosis of mucinous histology for patients with radically resected stage II and III colon cancer.
V. Catalano (2012)
10.1093/HSW/HLT022
Better colon cancer care for extremely poor Canadian women compared with American women.
K. Gorey (2013)
10.1371/journal.pone.0080188
Evaluation of Relapse-Free Survival in T3N0 Colon Cancer: The Role of Chemotherapy, a Multicentric Retrospective Analysis
R. Grande (2013)
10.1007/s00384-014-2056-y
Unfavorable effect of small tumor size on cause-specific survival in stage IIA colon cancer, a SEER-based study
Yuwei Wang (2014)
10.1016/j.ejso.2015.09.009
The impact of adjuvant chemotherapy timing on overall survival following colorectal cancer resection.
S. Nachiappan (2015)
10.1016/j.yexmp.2017.07.002
HtrA3 stromal expression is correlated with tumor budding in stage II colorectal cancer.
Catherine L Forse (2017)
10.1007/s10147-012-0424-6
Feasibility study of S-1 adjuvant chemotherapy in patients with colorectal cancer
Masaichi Ogawa (2012)
10.4172/2155-9899.1000269
Active (Patient Specific) Immunotherapy of Colon Cancer: A Transition from Preclinical Studies to Successful Clinical Trials
Michael G. Hanna (2014)
10.1200/jco.2011.29.15_suppl.e14150
Adjuvant chemotherapy for stage II colon cancer: Who (really) needs it?
Y. Yang (2011)
10.1016/j.suronc.2008.05.003
Technique and clinical consequences of sentinel lymph node biopsy in colorectal cancer.
A. Bembenek (2008)
10.1016/J.CANLET.2006.07.007
Molecular co-expression of the c-Met oncogene and hepatocyte growth factor in primary colon cancer predicts tumor stage and clinical outcome.
U. Kammula (2007)
Clinico-Pathological and Prognostic Significance of p53, Bcl-2 and Her-2/neu Protein Markers in Colorectal Cancer Using Tissue Microarray.
H. Ismail (2007)
10.1158/1055-9965.EPI-14-0544-T
MicroRNA Classifier and Nomogram for Metastasis Prediction in Colon Cancer
I. Goossens-Beumer (2014)
10.1186/s12014-019-9223-7
Combination of laser microdissection, 2D-DIGE and MALDI-TOF MS to identify protein biomarkers to predict colorectal cancer spread
Chandra Kirana (2019)
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