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.
References
Jemal A, Thomas A, Murray T, et al 2002;Cancer statistics, 2002. CA Cancer J Clin 52:23â47.
National Comprehensive Cancer Network. Clinical practice guidelines in oncology. JNCCN 2003;1:40â53.
Wolmark N, Fisher B, Rockette H, et al 1988;Postoperative adjuvant chemotherapy or BCG for colon cancer: results from the NSABP protocol Câ01. J Natl Cancer Inst 80:30â36.
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 7:1447â1456.
Moertel CG, Fleming TR, Macdonald JS, et al 1990;Levamisole and 5âfluorouracil for adjuvant therapy of resected colon cancer. N Engl J Med 322:352â358.
NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444â1450.
Taal BG, Van Tinteren H, Zoetmulder FA, et al 2001;Adjuvant 5âFU plus levamisole in colonic or rectal cancer: improved survival in stage II or III. Br J Cancer 85:1437â1443.
International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators: efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 1995;345:939â944.
Wolmark N, Rockette H, Fisher B, et al 1993;The benefit of leucovorinâmodulated fluorouracil as postoperative adjuvant therapy for primary colon cancer. Results form National Surgical Adjuvant Breast and Bowel Project protocol COâ3. J Clin Oncol 11:1879â1887.
O'Connell MJ, Laurie JA, Kahn M, et al 1998;Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with highârisk colon cancer. J Clin Oncol 16:295â300.
Haller DG, Catalano PJ, Mac DonaldJS, et al 1998;Fluorouracil (FU), leucovorin (LV) and levamisole (LEV) adjuvant therapy for colon cancer: fiveâyear final report of INTâ0089 [abstract]. Proc Am Soc Clin Oncol 17:256.
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 Dukesâ B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project COâ4. J Clin Oncol 17:3553â3559.
QUASAR Collaborative Group: comparison of fluorouracil with additional levamisole, higher dose leucovorin or both as adjuvant chemotherapy for colorectal cancerâa randomized trial. Lancet 2000;355:1588â1596.
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):S324â325. Abstr 1085.
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: 5738â5744.
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 360:1381â1391.
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;17:1356â1363.
Schrag D, Gelfand S, Bach P, et al 2001;Adjuvant chemotherapy for stage II colon cancer: insight from a SEERâMedicare cohort [abstract]. Proc Am Soc Clin Oncol 20:488.
Mamounas E, Wieand S, Wolmark N, et al 1999;Comparative efficacy of adjuvant chemotherapy in patients with Dukesâ B versus Dukesâ C colon cancer: results from four National Surgical Adjuvant Breast and Bowel Projects adjuvant studies (COâ1, COâ2, COâ3 and COâ4). J Clin Oncol 17:1349â1355.
Buyse M, Piedbois P. 2001;Should Dukesâ B patients receive adjuvant therapy? A statistical perspective. Semin Oncol 28(suppl 1):20â24.
Krook JE, Moertel CG, Gunderson LL, et al 1991;Effective surgical adjuvant therapy for highârisk rectal carcinoma. N Engl J Med 324:709â715.
Willett CG, Tepper JE, Cohen A, et al 1984;Local failure following curative resection of colonic adenocarcinoma. Int J Radiat Oncol Biol Phys 10:645â651.
Gunderson LL, Sosin H, Levitt S. 1985;Extrapelvic colonâareas of failure in a reoperation series: implications for adjuvant therapy. Int J Radiat Oncol Biol Phys 11:731â741.
Willett CG, Fung CY, Kaufman DS, et al 1993;Postoperative radiation therapy for highârisk colon carcinoma. J Clin Oncol 11: 1112â1117.
Schild SE, Gunderson LL, Haddock MG, et al 1997;The treatment of locally advanced colon cancer. Int J Radiat Oncol Biol Phys 37:51â58.
Amos EH, Mendenhall WM, McCarty PJ, et al 1996;Postoperative radiotherapy for locally advanced colon cancer. Ann Surg Oncol 3:431â436.
Martenson J, Willett CG, Sargent D, et al. A phase III study of adjuvant radiation therapy (RT), 5âfluorouracil (5âFU), and levamisole (LEV) vs. 5âFU and LEV in selected patients with resected, highârisk colon cancer: initial results of INT 0130 [abstract]. Proc Am Soc Clin Oncol 1999;18:235.
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 19:2576â2582.
Hoover HC Jr, Brandhorst JS, Peters LC, et al 1993;Adjuvant active specific immunotherapy for human colorectal cancer: 6.5 year median followâup of a phase III prospectively randomized trial. J Clin Oncol 11:390â399.
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;18:148â157.
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 353:345â350.
Camma C, Giunta M, Fiorica F, et al 2000;Preoperative radiotherapy for resectable rectal cancer: a metaâanalysis. JAMA 284: 1008â1015.
Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291â304.
Glimelius B, Grönberg H, JĂ€rhult J, Wallgren A, CavallinâStĂ„hl E. 2003;A systematic overview of radiation therapy in rectal cancer. Acta Oncol 42:476â492.
PĂ„hlman L, Glimelius B. 1990;Preâ or postoperative radiotherapy in rectal and rectosigmoid carcinoma: report from a randomized multicentre trial. Ann Surg 211:187â195.
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 Râ03) [abstract]. Proc Am Soc Clin Oncol 20:123a.
Sauer R, Fietkau R, Wittekind C, et al 2001;Adjuvant versus neoadjuvant radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 177:173â181.
GarciaâAguilar J, Pollack J, Lee SH, et al 2002;Accuracy of endorectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum 45:10â15.
BeetsâTan RGH, Beets GL, Vliegen RFA, et al 2001;Accuracy of magnetic resonance imaging in prediction of tumourâfree resection margin in rectal cancer surgery. Lancet 357:497â504.
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;80:1333â1336.
Heald RJ, Karanjia ND. 1992;Results of radical surgery for rectal cancer. World J Surg 16:848â857.
Enker WE. 1992;Potency, cure, and local control in the operative treatment of rectal cancer. Arch Surg 127:1396â1401.
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 32:307â315.
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.
Dahlberg M, Glimelius B, PĂ„hlman L. 1999;Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 86:379â84.
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 356:93â96.
Swedish Rectal Cancer Register. Available at: http://www.SOS.se/mars/kvaflik.htm (Swe).
Kapiteijn E, Matijnen CA, Naggtegaal ID, et al 2001;Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638â646.
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.
Fisher B, Wolmark N, Rockette H, et al 1988;Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer. Results from NSABP protocol Râ01. J Natl Cancer Inst 80:21â29.
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 Râ02. J Natl Cancer Inst 92:388â396.
Willett CG, Tepper JE, Kaufman DS, et al 1992;Adjuvant postoperative radiation therapy for rectal adenocarcinoma. Am J Clin Oncol 15:371â375.
Krook JE, Moertel CG, Gunderson LL, et al 1991;Effective surgical adjuvant therapy for highârisk rectal carcinoma. N Engl J Med 324:709â715.
Gastrointestinal Tumor Study Group. Adjuvant therapy of colon cancer: results of a prospective randomized trial. N Engl J Med 1984;310:737â743.
National Institutes of Health Consensus Conference: adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444â1450.
Tveit KM, Guldvog I, Hagen S, et al 1997;Randomised controlled trial of postoperative radiotherapy and shortâterm timeâscheduled 5âfluorouracil against surgery alone in the treatment of Dukes B and C rectal cancer. Br J Surg 84:1130â1135.
PĂ„hlman L, Enblad P, Glimelius B. 1985;Clinical characteristics and their relation to surgical curability in adenocarcinoma of the rectum and rectoâsigmoid: a populationâbased study in 279 consecutive patients. Acta Chir Scand 151:685â693.
Moertel CG, Childs DS, Reitemeier RJ, et al 1969;Combined 5âfluorouracil and supervoltage radiation therapy of locally unresectable gastrointestinal carcinoma. Lancet 2:865â867.
Overgaard M, Berthelsen K, Dahlmark M, et al. A randomized trial of radiotherapy alone or combined with 5âFU in the treatment of locally advanced colorectal carcinoma. ECCO 5, meeting abstract 1989:0â0626.
WassifâBoulis S. 1982;The role of preoperative adjuvant therapy in management of borderline operability of rectal cancer. Clin Radiol 33:353â358.
Frykholm GJ, Pahlman L, Glimelius B. 2001;Combined chemo and radiotherapy versus radiotherapy alone in the treatment of primary, nonâresectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 50:433â440.
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: 153â160.
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: 1121â1130.
GlynneâJones R, SebagâMontefiore D. 2002;Chemoradiation schedulesâwhat radiotherapy? Eur J Cancer 38:258â269.
Valentini V, Coco C, Cellini N, et al 1999;Preoperative chemoradiation with cisplatin and 5âfluorouracil for extraperitoneal T3 rectal cancer: acute toxicity tumor response, sphincter preservation. Int J Radiat Oncol Biol Phys 45:1175â1184.
Grann A, Minsky BD, Cohen AM, et al 1997;Preliminary results of preoperative 5âfluorouracil, lowâdose leucovorin and concurrent radiation therapy for clinically respectable T3 rectal cancer. Dis Colon Rectum 40:515â522.
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 Râ03. Dis Colon Rectum 40:131â139.
Rouanet P, SaintâAubert B, Lemanski C, et al 2002;Restorative and nonrestorative surgery for low rectal cancer after highâdose radiation. Dis Colon Rectum 45:305â315.
Mohiuddin M, Regine WF, Marks GJ, Marks JW. 1998;High dose preoperative radiation and the challenge of sphincterâpreservation surgery for rectal cancer of the distal 2 cm of the rectum. Int J Radiat Oncol Biol Phys 40:569â574.
HabrâGama A, de Souza PM, Ribeiro U, et al 1998;Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum 41:1087â1096.
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 combinedâmodality therapy. Ann Surg Oncol 1:80â85.
Karnjia ND, Schache DJ, Nort WR, Heald RJ. 1990;âClose shaveâ in anterior resection. Br J Surg 63:673â677.
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 sphincterâsparing surgery for rectal cancer: the Lyon R90â01 randomized trial. J Clin Oncol 17:2396â2402.
Bujko K, Nowacki MP, Bebenek M, et al 2004;Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing shortâterm radiotherapy versus conventionally fractionated radiochemotherapy. Radiother Oncol 72(1):15â24.
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: 26â30.
Taal BG, Van Tinteren H, Zoetmulder FA, et al 2001;Adjuvant 5âFU plus levamisole in colonic or rectal cancer: improved survival in stage II or III. Br J Cancer 85:1437â1443.
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, abstractâbook 2003;39(suppl 1):S318. Abstr 1066.
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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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DOI: https://doi.org/10.1007/978-0-387-36374-5_31
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