Adjuvant therapy of rectal cancer, including stage II – pro
Adjuvant chemotherapy for Stage II colon cancer is controversial but the field is now returning back to it and guideliens state that it is optional but accepted. There is greater acceptance for rectal cancer and NCCN lists Folfox or capecitabine with oxaliplatin. for adjuvant therapy of rectal cancer for stage II or III. Following neoadjuvant chemo, resection, adjuvant treatment recommendations per REC-4 lists FOLFOX and CapeOx.
Another point of uncertainty In rectal cancer is regarding preoperative versus postoperative treatment, ot both, and guidelines provide guidance in either situation. The one randomized study in the USA, R-03, that looked at the question found both approaches to be comparable. A German study is ongoing, with 800 patients. Both regimens incorporate four cycles of 5-day 5-FU administered in the postoperative setting.
Stage T3N0M0 is a special case, becasue much of the older literature may ahve understaged these patients. Now that endorectal uoltasound is routinely performed, there is more confedence that N0 really means “no invovled nodesP. NCCN at this point recommends chem for this group as well.
Roh MS, Petrelli N, Wieand S, et al: Phase III randomized trial of preoperative versus postoperative multimodality therapy in patients with carcinoma of the rectum (NSABP R-03) (abstract 490). Proc Am Soc Clin Oncol 20:123a, 2001.
NCCN.ORG, Colon Cancer 2013, REC-4
Capecitabine and Oxaliplatin in the Adjuvant Treatment of Stage III (Dukes’ C) Colon Cancer (TA100)
Technology Appraisal Guidance No. 100
http://www.mims.co.uk/Guidelines/882146/Capecitabine-Oxaliplatin-Adjuvant-Treatment-Stage-III-Dukes-C-Colon-Cancer-TA100/ 2009
Lisa A. Kachnic et al, Rectal Cancer at the Crossroads: The Dilemma of Clinically Staged T3, N0, M0 Disease, ournal of Clinical Oncology, Vol 26, No 3 (January 20), 2008: pp 350-351