Adjuvant Treatment of Colorectal Cancer

Abstract

Colorectal cancer is the fourth most common noncutaneous malignancy in the United States and the second most frequent cause of cancer-related death. Approximately three quarters of patients are diagnosed with disease limited to the bowel wall or surrounding lymph nodes. Over the past decade, significant progress has been made in the treatment of localized colorectal cancer due to advances in surgery, radiotherapy, and chemotherapy. For patients with Stage III colon cancer, an overall survival benefit for fluorouracil-based chemotherapy has been firmly established, and recent data have shown further efficacy through the inclusion of oxaliplatin into adjuvant treatment programs. For patients with Stage II colon cancer, the use of adjuvant chemotherapy remains controversial, but may be appropriate in a subset of individuals at high risk for disease recurrence. In the treatment of patients with rectal cancer, improved outcomes have been noted with the use of total mesorectal excision and preoperative concurrent chemoradiotherapy. Current randomized clinical trials in the adjuvant therapy of colorectal cancer are examining the value of adding agents known to be active in metastatic disease, including those that modify specific molecular targets. (CA Cancer J Clin 2007;57:168-185.)

Preoperative Vascular Endothelial Growth Factor Levels as a Prognostic Marker for Stage II or III Colorectal Cancer Patients

“…A number of studies have investigated the use of various combinations of molecular markers to predict clinical outcome in the hope that these may help to identify high-risk patients and hence enable appropriate neoadjuvant and/or adjuvant treatment. [27][28][29][30] In the present study, we showed that increased preoperative circulating VEGF levels were significantly correlated with tumor size, and nodal and distant metastases, which are well known prognostic factors. VEGF is a multifunctional cytokine that increases microvascular permeability and directly stimulates endothelial cell growth and angiogenesis, and many VEGF concentrations are an independent risk factor for colorectal tumor recurrence.…”

Combined analysis of VEGF and EGFR predicts complete tumour response in rectal cancer treated with preoperative radiotherapy

“…Patients with rectal cancers, comprising approximately 30% of these cases, are known to have an increased rate of local recurrence and decreased survival time compared with patients with tumours of the colon, a result due primarily to the surgical constraints imposed by the location of the rectum within the pelvis (Wolpin et al, 2007). As a consequence, the clinical management of patients with rectal cancer differs significantly from that of the colon in terms of surgical technique, the more frequent use of radiotherapy and method of chemotherapy administration.…”

XPO1 Inhibition Enhances Radiation Response in Preclinical Models of Rectal Cancer

“…Rectal cancer is a major health problem around the world, representing about one-third of the total colorectal cancer cases (1). The lack of serosa covering the rectum and the proximity of the rectum to other pelvic organs commonly leads to locally advanced disease.…”