Adjuvant Chemotherapy for Stage II Colorectal Cancer
Adjuvant Chemotherapy for Stage II Colorectal Cancer
Colorectal cancer is the second most common cause of cancer death in much of the developed world. Cancer-related mortality is slowly decreasing as a result of better detection and improved surgery. Adjuvant chemotherapy is now considered the standard treatment for stage III colon cancer, and has evolved recently with the introduction of infusional, combination chemotherapy. Adjuvant therapy for stage II colon cancer has been more controversial. Recent trial data suggest, however, that there is a legitimate case for discussing the advantages and limitations with individual patients.
In the past 20 years, significant changes in our understanding and treatment of colorectal cancer have been noted. Recognition of familial colorectal cancer syndromes, a greater appreciation of the value of screening, refinement of diagnostic techniques, super-specialization of surgeons, and increased availability of new chemotherapeutic agents, have all contributed to greater patient survival. Indeed, data from a French cancer registry indicate an improvement in 5-year survival resulting from all-stage colorectal cancer from 33% in 1976–1979 to 55.3% in 1992–1995. A corresponding increase in primary resection rate from 69.3% to 91.9% and an increase in the proportion of stage I or II patients at diagnosis from 39.6% to 56.6% was observed. The percentage of patients receiving adjuvant chemotherapy increased from 4.1% in 1989–1990 to 45.7% in 1997–1998. Unsurprisingly, efforts are now being made to improve outcome even in patients with a good prognosis, such as stage II colorectal cancer patients where 5-year survival is already approximately 80%.
Colorectal cancer is the second most common cause of cancer death in much of the developed world. Cancer-related mortality is slowly decreasing as a result of better detection and improved surgery. Adjuvant chemotherapy is now considered the standard treatment for stage III colon cancer, and has evolved recently with the introduction of infusional, combination chemotherapy. Adjuvant therapy for stage II colon cancer has been more controversial. Recent trial data suggest, however, that there is a legitimate case for discussing the advantages and limitations with individual patients.
In the past 20 years, significant changes in our understanding and treatment of colorectal cancer have been noted. Recognition of familial colorectal cancer syndromes, a greater appreciation of the value of screening, refinement of diagnostic techniques, super-specialization of surgeons, and increased availability of new chemotherapeutic agents, have all contributed to greater patient survival. Indeed, data from a French cancer registry indicate an improvement in 5-year survival resulting from all-stage colorectal cancer from 33% in 1976–1979 to 55.3% in 1992–1995. A corresponding increase in primary resection rate from 69.3% to 91.9% and an increase in the proportion of stage I or II patients at diagnosis from 39.6% to 56.6% was observed. The percentage of patients receiving adjuvant chemotherapy increased from 4.1% in 1989–1990 to 45.7% in 1997–1998. Unsurprisingly, efforts are now being made to improve outcome even in patients with a good prognosis, such as stage II colorectal cancer patients where 5-year survival is already approximately 80%.