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Adjuvant chemotherapy for resected stage II colon cancer

Hanna K Sanoff, MD, MPH
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


Approximately 95,520 new cases of colon cancer are diagnosed annually in the United States [1]. Surgical resection is the only curative treatment for locoregional disease. Outcome is most closely related to the extent of disease at presentation (table 1 and figure 1) [2]. (See "Clinical presentation, diagnosis, and staging of colorectal cancer", section on 'TNM staging system'.)

For patients who have undergone potentially curative resection, disease recurrence is thought to arise from clinically occult micrometastases that are present at the time of surgery. The goal of postoperative (adjuvant) therapy is to eradicate these micrometastases, thereby increasing the cure rate.

The benefits of adjuvant chemotherapy have been most clearly demonstrated in stage III (node-positive (table 1)) disease (an approximately 30 percent relative reduction in the risk of disease recurrence and a 22 to 32 percent relative reduction in mortality), and it has become a standard approach in this setting. The benefits of adjuvant chemotherapy in stage II (node-negative) disease are less certain, and the use of chemotherapy in this group is variable.

This topic review will cover adjuvant therapy for patients with resected stage II colon cancer. Trials demonstrating the benefit of adjuvant therapy for patients with stage III (node-positive) colon cancer, optimal timing of adjuvant therapy, use of adjuvant regional liver-directed therapy and adjuvant radiation therapy, colon cancer in elderly patients, surgical management and prognosis of colon cancer, chemotherapy after resection of colorectal cancer liver metastases, and recommendations for posttreatment follow-up are discussed separately. (See "Adjuvant therapy for resected stage III (node-positive) colon cancer" and "Adjuvant therapy for resected colon cancer in elderly patients" and "Overview of the management of primary colon cancer" and "Management of potentially resectable colorectal cancer liver metastases" and "Surveillance after colorectal cancer resection".)


Fluoropyrimidine-based chemotherapy — The benefits of fluoropyrimidine-based adjuvant systemic therapy have been clearly shown for patients with stage III disease. Multiple clinical trials have tested the value of such therapy in resected stage II colon cancer, showing at best a small disease-free survival (DFS) and a very small overall survival benefit from adjuvant therapy.

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Literature review current through: Nov 2017. | This topic last updated: Jun 29, 2017.
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