Oncologists issue guidelines for stage II colon cancer
Last Updated: August 17, 2004



NEW YORK (Reuters Health) - After conducting a meta-analysis of
recent trial data, researchers from the American Society of Clinical
Oncology (ASCO) found no direct evidence to support the use of
adjuvant chemotherapy in medically fit patients with stage II disease.


However, such therapy may be considered for certain subgroups of
patients, such as those with inadequately sampled nodes, T4 lesions,
poorly differentiated histology, or perforation, the researchers
report in the August 15th issue of the Journal of Clinical Oncology.

To formulate guidelines for adjuvant chemotherapy in stage II colon
cancer, Dr. Al B. Benson III, from Northwestern University Feinberg
School of Medicine in Chicago, and colleagues conducted a literature
review through May 2003.

The meta-analysis focused on 12 trials, reported between 1985 and
2001, which included a surgery only control arm and at least one
fluorouracil-based chemotherapy arm.

Treatment with adjuvant chemotherapy did not provide a significant
survival benefit for patients with stage II disease, the results
showed. Based on this finding, Dr. Benson's group does not recommend
adjuvant chemotherapy for medically fit patients with stage II colon
cancer.

For high-risk patients or those with poor prognosis stage II disease,
the appropriate treatment course is less clear. Although direct
evidence does not support the use of adjuvant chemotherapy, there
have been concerns that studies to date have lacked adequate power to
reach this conclusion. In addition, experience with stage III
disease, might lead clinicians to believe that chemotherapy is also
useful for stage II disease.

For these reasons, the authors recommend that clinicians discuss "the
potential, yet uncertain, benefits of treatment and the accompanying
side effects" with high-risk patients.

"The (ASCO) Panel emphasizes that the treatment decision-making
process in stage II colon cancer must incorporate patient choice, and
that the responsibility of both surgical and medical oncologists is
to ensure that the patient has adequate information to make a well-
informed decision that incorporates personal preferences," the
researchers note.





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