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American Society of Clinical Oncology Recommendations on Adjuvant Chemotherapy for Stage II Colon Cancer
Link to a PDF Version of this Guideline by Al B. Benson III, et al. J Clin Oncol 2004;22:3408–3419. (http://www.asco.org/ac/1,1003,_12-002032-00_18-0034698-00_19-0032489-00_20-001,00.asp)
The American Society of Clinical Oncology has made continuous efforts to improve general practice by publishing several practice guidelines for community oncologists. On this occasion, recommendation on adjuvant chemotherapy for stage II colon cancer has been published based on systematic review by an expert panel. Adjuvant chemotherapy for stage III colon cancer was established as six-month treatment with 5-FU plus leucovorin. However, adjuvant chemotherapy for stage II colon cancer is still controversial. This recommendation was based on systematic reviews through May 2003, concerning large scale randomized trials of adjuvant chemotherapy compared with surgery alone, in collaboration with the Cancer Care Ontario Practice Guideline Initiative. In stage II colon cancer patients, there were no statistically significant differences between arms. In high-risk patients, including onset with bowel obstruction or perforation, many patients received adjuvant chemotherapy in routine practice although there was no clear evidence of favor to adjuvant chemotherapy. In this recommendation, the reviewers noted that 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.
In conclusion, the ultimate clinical decision should be based on discussion 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. This is a typical application of practice guidelines on the clinical setting. Good communication with each patient is a very important element in medical practice. Further advances on this issue should include encouraging patients with stage II disease to participate in randomized trials. Recently, the TNM staging system for stage II and III colon cancer was revised. The new version of stage IIIa has a better survival compared to stage IIb (J Natl Cancer Inst 2004;96:1420–5). Indication of adjuvant chemotherapy should be considered according to the appropriate staging system.
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