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Adjuvant Therapy for Colorectal Cancer

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The ASCRS Textbook of Colon and Rectal Surgery

Abstract

The stage of disease at presentation remains the most important prognostic factor for colon cancer patients. Stage I disease carries an excellent prognosis of more than 95% 5-year survival rate, and surgical treatment alone is considered sufficient; adjuvant treatment is not indicated. In contrast, adjuvant treatment has repeatedly been shown to improve survival for Stage III disease. The role of adjuvant treatment for Stage II (node-negative) disease remains controversial.

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References

  1. Jemal A, Thomas A, Murray T, et al 2002;Cancer statistics, 2002. CA Cancer J Clin 52:23–47.

    Article  Google Scholar 

  2. National Comprehensive Cancer Network. Clinical practice guidelines in oncology. JNCCN 2003;1:40–53.

    Google Scholar 

  3. Wolmark N, Fisher B, Rockette H, et al 1988;Postoperative adjuvant chemotherapy or BCG for colon cancer: results from the NSABP protocol C‐01. J Natl Cancer Inst 80:30–36.

    Article  CAS  Google Scholar 

  4. Laurie JA, Moertel CG, FlemingTR, et al 1989;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 Clin Oncol 7:1447–1456.

    CAS  Google Scholar 

  5. Moertel CG, Fleming TR, Macdonald JS, et al 1990;Levamisole and 5‐fluorouracil for adjuvant therapy of resected colon cancer. N Engl J Med 322:352–358.

    Article  CAS  Google Scholar 

  6. NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–1450.

    Google Scholar 

  7. Taal BG, Van Tinteren H, Zoetmulder FA, et al 2001;Adjuvant 5‐FU plus levamisole in colonic or rectal cancer: improved survival in stage II or III. Br J Cancer 85:1437–1443.

    Article  CAS  Google Scholar 

  8. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators: efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 1995;345:939–944.

    Google Scholar 

  9. Wolmark N, Rockette H, Fisher B, et al 1993;The benefit of leucovorin‐modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer. Results form National Surgical Adjuvant Breast and Bowel Project protocol CO‐3. J Clin Oncol 11:1879–1887.

    CAS  Google Scholar 

  10. O'Connell MJ, Laurie JA, Kahn M, et al 1998;Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high‐risk colon cancer. J Clin Oncol 16:295–300.

    Google Scholar 

  11. Haller DG, Catalano PJ, Mac DonaldJS, et al 1998;Fluorouracil (FU), leucovorin (LV) and levamisole (LEV) adjuvant therapy for colon cancer: five‐year final report of INT‐0089 [abstract]. Proc Am Soc Clin Oncol 17:256.

    Google Scholar 

  12. Wolmark N, Rockette H, Mamounas E, et al 1999;Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluorouracil, leucovorin and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project CO‐4. J Clin Oncol 17:3553–3559.

    CAS  Google Scholar 

  13. QUASAR Collaborative Group: comparison of fluorouracil with additional levamisole, higher dose leucovorin or both as adjuvant chemotherapy for colorectal cancer—a randomized trial. Lancet 2000;355:1588–1596.

    Google Scholar 

  14. Topham C, Boni C, Navarro M, et al 2003;Multicenter international randomized study of oxaliplatin/5FU/LV (FOLFOX) in stage II and III colon cancer (MOSAIC trial): final results. Eur J Cancer 1(suppl 5):S324–325. Abstr 1085.

    Google Scholar 

  15. Fallik D, Borrini F, Boige V, et al 2003;Microsatellite instability is a predictive factor of the tumor response to irinotecan in patients with advanced colorectal cancer. Cancer Res 15: 5738–5744.

    Google Scholar 

  16. Barratt PL, Seymour MT, Stenning SP, et al 2002;DNA markers predicting benefit from adjuvant fluorouracil in patients with colorectal cancer: a molecular study. Lancet 360:1381–1391.

    Article  CAS  Google Scholar 

  17. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators: efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. J Clin Oncol 1999;17:1356–1363.

    Google Scholar 

  18. Schrag D, Gelfand S, Bach P, et al 2001;Adjuvant chemotherapy for stage II colon cancer: insight from a SEER‐Medicare cohort [abstract]. Proc Am Soc Clin Oncol 20:488.

    Google Scholar 

  19. Mamounas E, Wieand S, Wolmark N, et al 1999;Comparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Projects adjuvant studies (CO‐1, CO‐2, CO‐3 and CO‐4). J Clin Oncol 17:1349–1355.

    CAS  Google Scholar 

  20. Buyse M, Piedbois P. 2001;Should Dukes’ B patients receive adjuvant therapy? A statistical perspective. Semin Oncol 28(suppl 1):20–24.

    Article  CAS  Google Scholar 

  21. Krook JE, Moertel CG, Gunderson LL, et al 1991;Effective surgical adjuvant therapy for high‐risk rectal carcinoma. N Engl J Med 324:709–715.

    Article  CAS  Google Scholar 

  22. Willett CG, Tepper JE, Cohen A, et al 1984;Local failure following curative resection of colonic adenocarcinoma. Int J Radiat Oncol Biol Phys 10:645–651.

    Article  CAS  Google Scholar 

  23. Gunderson LL, Sosin H, Levitt S. 1985;Extrapelvic colon‐areas of failure in a reoperation series: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 11:731–741.

    Article  CAS  Google Scholar 

  24. Willett CG, Fung CY, Kaufman DS, et al 1993;Postoperative radiation therapy for high‐risk colon carcinoma. J Clin Oncol 11: 1112–1117.

    CAS  Google Scholar 

  25. Schild SE, Gunderson LL, Haddock MG, et al 1997;The treatment of locally advanced colon cancer. Int J Radiat Oncol Biol Phys 37:51–58.

    Article  CAS  Google Scholar 

  26. Amos EH, Mendenhall WM, McCarty PJ, et al 1996;Postoperative radiotherapy for locally advanced colon cancer. Ann Surg Oncol 3:431–436.

    Article  CAS  Google Scholar 

  27. Martenson J, Willett CG, Sargent D, et al. A phase III study of adjuvant radiation therapy (RT), 5‐fluorouracil (5‐FU), and levamisole (LEV) vs. 5‐FU and LEV in selected patients with resected, high‐risk colon cancer: initial results of INT 0130 [abstract]. Proc Am Soc Clin Oncol 1999;18:235.

    Google Scholar 

  28. Hanna MG Jr, Hoover HC Jr, Vermoken JB, et al. 2001;Adjuvant active specific immunotherapy of stage II and stage III colon cancer with autologous tumor cell vaccine: First randomized phase III trials show promise. Vaccine 19:2576–2582.

    Article  Google Scholar 

  29. Hoover HC Jr, Brandhorst JS, Peters LC, et al 1993;Adjuvant active specific immunotherapy for human colorectal cancer: 6.5 year median follow‐up of a phase III prospectively randomized trial. J Clin Oncol 11:390–399.

    Google Scholar 

  30. Harris JE, Ryan L, Hoover HC Jr, et al. Adjuvant active specific immunotherapy for stage II and II colon cancer autologous tumor cell vaccine: Eastern Cooperative Oncology Group Study E5238. J Clin Oncol 2000;18:148–157.

    CAS  Google Scholar 

  31. Vermoken JB, Claessen AM, Van Tinteren H, et al 1999;Active specific immunotherapy for stage II and stage III human colon cancer: a randomized trial. Lancet 353:345–350.

    Article  Google Scholar 

  32. Camma C, Giunta M, Fiorica F, et al 2000;Preoperative radiotherapy for resectable rectal cancer: a meta‐analysis. JAMA 284: 1008–1015.

    Article  CAS  Google Scholar 

  33. Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291–304.

    Google Scholar 

  34. Glimelius B, Grönberg H, JĂ€rhult J, Wallgren A, Cavallin‐StĂ„hl E. 2003;A systematic overview of radiation therapy in rectal cancer. Acta Oncol 42:476–492.

    Article  Google Scholar 

  35. PĂ„hlman L, Glimelius B. 1990;Pre‐ or postoperative radiotherapy in rectal and rectosigmoid carcinoma: report from a randomized multicentre trial. Ann Surg 211:187–195.

    Article  Google Scholar 

  36. Roh MS, Petrilli N, Wieand H, et al 2001;Phase III randomized trial of preoperative versus postoperative multimodality therapy in patients with carcinoma of the rectum (NSABP R‐03) [abstract]. Proc Am Soc Clin Oncol 20:123a.

    Google Scholar 

  37. Sauer R, Fietkau R, Wittekind C, et al 2001;Adjuvant versus neoadjuvant radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 177:173–181.

    Article  CAS  Google Scholar 

  38. Garcia‐Aguilar J, Pollack J, Lee SH, et al 2002;Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum 45:10–15.

    Article  Google Scholar 

  39. Beets‐Tan RGH, Beets GL, Vliegen RFA, et al 2001;Accuracy of magnetic resonance imaging in prediction of tumour‐free resection margin in rectal cancer surgery. Lancet 357:497–504.

    Article  Google Scholar 

  40. Swedish Rectal Cancer Trial: initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Br J Surg 1993;80:1333–1336.

    Google Scholar 

  41. Heald RJ, Karanjia ND. 1992;Results of radical surgery for rectal cancer. World J Surg 16:848–857.

    Article  CAS  Google Scholar 

  42. Enker WE. 1992;Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127:1396–1401.

    CAS  Google Scholar 

  43. Moriya Y, Hojo K, Sawada T, Koyama Y. 1989;Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32:307–315.

    Article  CAS  Google Scholar 

  44. Wibe A, Rendedal PR, Svensson E, et al 2002;Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327.

    Article  CAS  Google Scholar 

  45. Dahlberg M, Glimelius B, PĂ„hlman L. 1999;Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 86:379–84.

    Article  CAS  Google Scholar 

  46. Martling AL, Holm T, et al 2000;Effect of a surgical training programme on the outcome of rectal cancer in the County of Stockholm. Lancet 356:93–96.

    Article  CAS  Google Scholar 

  47. Swedish Rectal Cancer Register. Available at: http://www.SOS.se/mars/kvaflik.htm (Swe).

  48. Kapiteijn E, Matijnen CA, Naggtegaal ID, et al 2001;Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646.

    Article  CAS  Google Scholar 

  49. Bosset JF, Pierat M, Van Glabbeke M. 2000;Preoperative radiochemotherapy versus preoperative radiotherapy with or without postoperative chemotherapy: progress report of the EORTC 22921 trial [abstract]. Radiother Oncol 56:S52.

    Google Scholar 

  50. Fisher B, Wolmark N, Rockette H, et al 1988;Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer. Results from NSABP protocol R‐01. J Natl Cancer Inst 80:21–29.

    Article  CAS  Google Scholar 

  51. Wolmark N, Weiand HS, Hyams DM, et al 2000;Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project protocol R‐02. J Natl Cancer Inst 92:388–396.

    Article  CAS  Google Scholar 

  52. Willett CG, Tepper JE, Kaufman DS, et al 1992;Adjuvant postoperative radiation therapy for rectal adenocarcinoma. Am J Clin Oncol 15:371–375.

    Article  CAS  Google Scholar 

  53. Krook JE, Moertel CG, Gunderson LL, et al 1991;Effective surgical adjuvant therapy for high‐risk rectal carcinoma. N Engl J Med 324:709–715.

    Article  CAS  Google Scholar 

  54. Gastrointestinal Tumor Study Group. Adjuvant therapy of colon cancer: results of a prospective randomized trial. N Engl J Med 1984;310:737–743.

    Google Scholar 

  55. National Institutes of Health Consensus Conference: adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–1450.

    Google Scholar 

  56. Tveit KM, Guldvog I, Hagen S, et al 1997;Randomised controlled trial of postoperative radiotherapy and short‐term time‐scheduled 5‐fluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Br J Surg 84:1130–1135.

    Article  CAS  Google Scholar 

  57. PĂ„hlman L, Enblad P, Glimelius B. 1985;Clinical characteristics and their relation to surgical curability in adenocarcinoma of the rectum and recto‐sigmoid: a population‐based study in 279 consecutive patients. Acta Chir Scand 151:685–693.

    Google Scholar 

  58. Moertel CG, Childs DS, Reitemeier RJ, et al 1969;Combined 5‐fluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal carcinoma. Lancet 2:865–867.

    Article  CAS  Google Scholar 

  59. Overgaard M, Berthelsen K, Dahlmark M, et al. A randomized trial of radiotherapy alone or combined with 5‐FU in the treatment of locally advanced colorectal carcinoma. ECCO 5, meeting abstract 1989:0‐0626.

    Google Scholar 

  60. Wassif‐Boulis S. 1982;The role of preoperative adjuvant therapy in management of borderline operability of rectal cancer. Clin Radiol 33:353–358.

    Article  Google Scholar 

  61. Frykholm GJ, Pahlman L, Glimelius B. 2001;Combined chemo and radiotherapy versus radiotherapy alone in the treatment of primary, non‐resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 50:433–440.

    Article  Google Scholar 

  62. Janjan NA, Abbruzzese J, Pazdur R, et al 1999;Prognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer. Radiother Oncol 51: 153–160.

    Article  CAS  Google Scholar 

  63. Bouzourene H, Bosman FT, Seelentag W, Matter M, Coucke P. 2002;Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer 94: 1121–1130.

    Article  Google Scholar 

  64. Glynne‐Jones R, Sebag‐Montefiore D. 2002;Chemoradiation schedules—what radiotherapy? Eur J Cancer 38:258–269.

    Article  Google Scholar 

  65. Valentini V, Coco C, Cellini N, et al 1999;Preoperative chemoradiation with cisplatin and 5‐fluorouracil for extraperitoneal T3 rectal cancer: acute toxicity tumor response, sphincter preservation. Int J Radiat Oncol Biol Phys 45:1175–1184.

    Article  CAS  Google Scholar 

  66. Grann A, Minsky BD, Cohen AM, et al 1997;Preliminary results of preoperative 5‐fluorouracil, low‐dose leucovorin and concurrent radiation therapy for clinically respectable T3 rectal cancer. Dis Colon Rectum 40:515–522.

    Article  CAS  Google Scholar 

  67. Hyams DM, Mamounas EP, Petrelli N, et al 1997;A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R‐03. Dis Colon Rectum 40:131–139.

    Article  CAS  Google Scholar 

  68. Rouanet P, Saint‐Aubert B, Lemanski C, et al 2002;Restorative and nonrestorative surgery for low rectal cancer after high‐dose radiation. Dis Colon Rectum 45:305–315.

    Article  Google Scholar 

  69. Mohiuddin M, Regine WF, Marks GJ, Marks JW. 1998;High dose preoperative radiation and the challenge of sphincter‐preservation surgery for rectal cancer of the distal 2 cm of the rectum. Int J Radiat Oncol Biol Phys 40:569–574.

    Article  CAS  Google Scholar 

  70. Habr‐Gama A, de Souza PM, Ribeiro U, et al 1998;Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum 41:1087–1096.

    Article  Google Scholar 

  71. Moore HG, Riedel E, Minsky BD, et al 2003;Adequacy of 1 cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined‐modality therapy. Ann Surg Oncol 1:80–85.

    Article  Google Scholar 

  72. Karnjia ND, Schache DJ, Nort WR, Heald RJ. 1990;‘Close shave’ in anterior resection. Br J Surg 63:673–677.

    Google Scholar 

  73. Francois Y, Nemoz CJ, Baulieux J, et al 1999; Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter‐sparing surgery for rectal cancer: the Lyon R90‐01 randomized trial. J Clin Oncol 17:2396–2402.

    CAS  PubMed  Google Scholar 

  74. Bujko K, Nowacki MP, Bebenek M, et al 2004;Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short‐term radiotherapy versus conventionally fractionated radiochemotherapy. Radiother Oncol 72(1):15–24.

    Article  CAS  Google Scholar 

  75. Frigell A, Ottander M, Stenbeck H, PĂ„hlman L. 1990;Quality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma. Ann Chir Gynaecol 79: 26–30.

    CAS  Google Scholar 

  76. Taal BG, Van Tinteren H, Zoetmulder FA, et al 2001;Adjuvant 5‐FU plus levamisole in colonic or rectal cancer: improved survival in stage II or III. Br J Cancer 85:1437–1443.

    Article  CAS  Google Scholar 

  77. Glimelius B, Cedermark B, Dahl O, et al. Adjuvant chemotherapy in colorectal cancer: joint analyses of randomised trials by the Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Eur J Cancer, ECCO 12, abstract‐book 2003;39(suppl 1):S318. Abstr 1066.

    Google Scholar 

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Trudel, J.L., PĂ„hlman, L.A. (2007). Adjuvant Therapy for Colorectal Cancer. In: Wolff, B.G., et al. The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-36374-5_31

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