Advertisement

Adjuvant Therapy for Colorectal Cancer

  • Judith L. Trudel
  • Lars A. Påhlman
Reference work entry

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.

Keywords

Rectal Cancer Total Mesorectal Excision Local Recurrence Rate Preoperative Radiotherapy Colon Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Jemal A, Thomas A, Murray T, et al 2002;Cancer statistics, 2002. CA Cancer J Clin 52:23–47.CrossRefGoogle Scholar
  2. 2.
    National Comprehensive Cancer Network. Clinical practice guidelines in oncology. JNCCN 2003;1:40–53.Google Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.Google Scholar
  5. 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.CrossRefGoogle Scholar
  6. 6.
    NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–1450.Google Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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. 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.Google Scholar
  10. 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. 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. 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.Google Scholar
  13. 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. 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. 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. 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.CrossRefGoogle Scholar
  17. 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. 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. 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.Google Scholar
  20. 20.
    Buyse M, Piedbois P. 2001;Should Dukes’ B patients receive adjuvant therapy? A statistical perspective. Semin Oncol 28(suppl 1):20–24.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 24.
    Willett CG, Fung CY, Kaufman DS, et al 1993;Postoperative radiation therapy for high‐risk colon carcinoma. J Clin Oncol 11: 1112–1117.Google Scholar
  25. 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.CrossRefGoogle Scholar
  26. 26.
    Amos EH, Mendenhall WM, McCarty PJ, et al 1996;Postoperative radiotherapy for locally advanced colon cancer. Ann Surg Oncol 3:431–436.CrossRefGoogle Scholar
  27. 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. 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.CrossRefGoogle Scholar
  29. 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. 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.Google Scholar
  31. 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.CrossRefGoogle Scholar
  32. 32.
    Camma C, Giunta M, Fiorica F, et al 2000;Preoperative radiotherapy for resectable rectal cancer: a meta‐analysis. JAMA 284: 1008–1015.CrossRefGoogle Scholar
  33. 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. 34.
    Glimelius B, Grönberg H, Järhult J, Wallgren A, Cavallin‐Ståhl E. 2003;A systematic overview of radiation therapy in rectal cancer. Acta Oncol 42:476–492.CrossRefGoogle Scholar
  35. 35.
    Påhlman L, Glimelius B. 1990;Pre‐ or postoperative radiotherapy in rectal and rectosigmoid carcinoma: report from a randomized multicentre trial. Ann Surg 211:187–195.CrossRefGoogle Scholar
  36. 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. 37.
    Sauer R, Fietkau R, Wittekind C, et al 2001;Adjuvant versus neoadjuvant radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 177:173–181.CrossRefGoogle Scholar
  38. 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.CrossRefGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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. 41.
    Heald RJ, Karanjia ND. 1992;Results of radical surgery for rectal cancer. World J Surg 16:848–857.CrossRefGoogle Scholar
  42. 42.
    Enker WE. 1992;Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127:1396–1401.Google Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.CrossRefGoogle Scholar
  45. 45.
    Dahlberg M, Glimelius B, Påhlman L. 1999;Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 86:379–84.CrossRefGoogle Scholar
  46. 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.CrossRefGoogle Scholar
  47. 47.
    Swedish Rectal Cancer Register. Available at: http://www.SOS.se/mars/kvaflik.htm (Swe).
  48. 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.CrossRefGoogle Scholar
  49. 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. 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.CrossRefGoogle Scholar
  51. 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.CrossRefGoogle Scholar
  52. 52.
    Willett CG, Tepper JE, Kaufman DS, et al 1992;Adjuvant postoperative radiation therapy for rectal adenocarcinoma. Am J Clin Oncol 15:371–375.CrossRefGoogle Scholar
  53. 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.CrossRefGoogle Scholar
  54. 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. 55.
    National Institutes of Health Consensus Conference: adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–1450.Google Scholar
  56. 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.CrossRefGoogle Scholar
  57. 57.
    Påhlman 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. 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.CrossRefGoogle Scholar
  59. 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. 60.
    Wassif‐Boulis S. 1982;The role of preoperative adjuvant therapy in management of borderline operability of rectal cancer. Clin Radiol 33:353–358.CrossRefGoogle Scholar
  61. 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.CrossRefGoogle Scholar
  62. 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.CrossRefGoogle Scholar
  63. 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.CrossRefGoogle Scholar
  64. 64.
    Glynne‐Jones R, Sebag‐Montefiore D. 2002;Chemoradiation schedules—what radiotherapy? Eur J Cancer 38:258–269.CrossRefGoogle Scholar
  65. 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.CrossRefGoogle Scholar
  66. 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.CrossRefGoogle Scholar
  67. 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.CrossRefGoogle Scholar
  68. 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.CrossRefGoogle Scholar
  69. 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.CrossRefGoogle Scholar
  70. 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.CrossRefGoogle Scholar
  71. 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.CrossRefGoogle Scholar
  72. 72.
    Karnjia ND, Schache DJ, Nort WR, Heald RJ. 1990;‘Close shave’ in anterior resection. Br J Surg 63:673–677.Google Scholar
  73. 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.PubMedGoogle Scholar
  74. 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.CrossRefGoogle Scholar
  75. 75.
    Frigell A, Ottander M, Stenbeck H, Påhlman L. 1990;Quality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma. Ann Chir Gynaecol 79: 26–30.Google Scholar
  76. 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.CrossRefGoogle Scholar
  77. 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

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Judith L. Trudel
  • Lars A. Påhlman

There are no affiliations available

Personalised recommendations