In this study, doctors from the American Society of Clinical Oncology assessed whether patients with curatively resected stage II colon cancer should be offered adjuvant chemotherapy as part of routine clinical practice.
The team also identified patients with poor prognosis characteristics, and described strategies for oncologists to use to discuss adjuvant chemotherapy in practice.
The team, in collaboration with the Cancer Care Ontario Practice Guideline Initiative, conducted a review of the literature through to May 2003.
They performed a meta-analysis of the identified literature.
The doctors found no evidence of a statistically significant survival benefit of adjuvant chemotherapy for stage II patients.
|Some patients with stage II disease may be considered for adjuvant therapy.|
|Journal of Clinical Oncology|
They were unable to recommend the routine use of adjuvant chemotherapy for medically fit patients with stage II colon cancer.
However, some patients with stage II disease may be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology.
Dr Al Benson and colleagues concluded, "Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer".
"Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease".
"The ultimate clinical decision should be based on discussions 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".
"Patients with stage II disease should be encouraged to participate in randomized trials".