Physicians’ Beliefs About the Benefits and Risks of Adjuvant Therapies for Stage II and Stage III Colorectal Cancer

Wong, Anthony; Stock, Shannon; Schrag, Deborah; Kahn, Katherine L.; Salz, Talya; Charlton, Mary E.; Rogers, Shelia; Keating, Nancy L.; Goodman, Karyn A.

doi:10.1016/j.ijrobp.2014.05.1773

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…In addition, any potential benefit may be obscured by other factors such as heterogeneity of the subgroups, insufficient number of patients in clinical trials, competing co-morbidities causing non-cancer related deaths and under-staging of subjects with inadequate nodal resection (Buyse and Piedbois, 2001). Due to inconsistency in evidence, physician's belief over the net benefit of adjuvant therapies for Dukes B cancer also remains divided (Wong et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors and the Role of Adjuvant Chemotherapy in Post-curative Surgery for Dukes B and C Colon Cancers and Survival Outcomes: a Malaysian Experience

Hassan¹,

Naicker²,

Yusof³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Adjuvant chemotherapy improves survival in Dukes C colon cancers post-curative resection. However, the evidence for a role with Dukes B lesions remains unproven despite frequent use for disease characterized by poor prognostic features. In view of limited Asia-specific data, this study aimed to determine survival outcomes and identify prognostic factors in a tertiary teaching hospital in Malaysia. Materials and Methods: A total of 116 subjects who underwent curative surgery with and without adjuvant chemotherapy for Duke B and C primary colon adenocarcinomas diagnosed from 2004-2009 were recruited and data were collected retrospectively. Five-year overall survival (OS) and disease free survival (DFS) were analysed using Kaplan-Meier survival analysis and log-rank (Mantel-Cox) test. Prognostic factors were determined using Cox proportional hazards regression with both univariate and multivariate analyses. Results: The survival analysis demonstrated a 5-year OS of 74.0% for all patients, with 74.9% for Dukes C subjects receiving chemotherapy compared to 28.6% in those not receiving chemotherapy (p=0.001). For Dukes B disease, the 5-year survival rate was 82.6% compared to 75.0% for subjects receiving and not receiving chemotherapy, respectively (p=0.17). Independent prognostic factors identified included a CEA level more than 3.5 ng/ml (hazard ratio (HR)=4.78; p=0.008), serosal involvement (HR=3.75; p=0.028) and completion of chemotherapy (HR= 0.20; p=0.007). Conclusions: In a regional context, this study supports current evidence from the West that adjuvant chemotherapy improves survival in Dukes C colon cancers post curative surgery. However, although a clear benefit has yet to be proven for Dukes B disease, our results suggest survival improvement in selected cases.

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Section: Discussionmentioning

confidence: 99%

Prognostic Factors and the Role of Adjuvant Chemotherapy in Post-curative Surgery for Dukes B and C Colon Cancers and Survival Outcomes: a Malaysian Experience

Hassan¹,

Naicker²,

Yusof³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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“…The choice between bolus 5-FU, infusional 5-FU, and oral fluoropyrimidines is based on a combination of physician and patient preferences, access to oral drugs, catheters, and geography. Also, the belief in benefit of adjuvant chemotherapy in rectal cancer can vary according to the medical specialist being consulted [36]. The use of oxaliplatin is guided by studies conducted in colon cancer and should not be used concomitantly with RT, because most studies with oxaliplatin in the neoadjuvant setting demonstrated increased toxicity without improving results [23-26, 27••].…”

Section: Resultsmentioning

confidence: 99%

Is There a Role for Adjuvant Chemotherapy in Rectal Cancer?

Prolla

2015

Curr Colorectal Cancer Rep

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Adjuvant chemoradiotherapy trials demonstrated a reduction in local failure and an increase in survival of patients with locally advanced rectal cancer submitted to upfront surgery. The standard-of-care shifted to neoadjuvant chemoradiotherapy when the German Rectal Cancer Study Group Trial demonstrated the benefit of neoadjuvant compared to adjuvant fluoropyrimidine chemoradiotherapy in lower rates of local failure, lower toxicity in patients optimally resected with total mesorectal excision (TME), and higher rate of sphinctersparing surgery. Overall survival (OS) was equivalent in both arms. The benefit of adjuvant chemotherapy after preoperative chemoradiotherapy has not been clearly demonstrated in randomized trials. This review will discuss the role of fluoropyrimidine-based and oxaliplatin-based adjuvant chemotherapy in patients treated with neoadjuvant chemoradiotherapy.

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“…Although recent chemotherapeutic development has improved the overall outcomes of advanced metastatic CRC, metastasis influences the prognosis. In stage II, about 13% of patients experience recurrence after curative resection, and the administration of adjuvant chemotherapy for patients with stage II CRC is controversial (12). The explorative CART analysis was used to define the relevant prognostic groups concerning survival probability.…”

Section: Discussionmentioning

confidence: 99%

A novel prognostic prediction model for recurrence in patients with stage II colon cancer after curative resection.

Saso

Miyoshi

Fujino

et al. 2018

JCO

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The present study aimed to clarify the risk factors for recurrence of stage II colon cancer in patients and to determine possible treatment options for postoperative adjuvant chemotherapy. A prediction model for recurrence in patients with stage II colon cancer after curative surgical resection was developed. The present study retrospectively investigated 436 patients who underwent curative resection for stage II colon cancer at Osaka International Cancer Institute and Yao Municipal Hospital between 2004 and 2012. Several clinicopathological factors were examined and the Cox regression model was used to develop a prediction model for recurrence. The prediction model was validated in an independent group of 213 patients who underwent surgery at Osaka University Hospital between 2001 and 2012. Univariate analysis revealed that preoperative serum carcinoembryonic antigen level, preoperative obstruction, tumor invasion, lymphatic invasion and venous invasion were significantly correlated with disease-free survival. Using these variables, a classification and regression tree was constructed as a prediction model. The prediction models were validated by external datasets in an independent patient group. The concordance indices for DFS after current surgical resection were 0.675 in the learning set and 0.552 in the validation set. To conclude, a novel, reliable and personalized prognostic model was developed to predict recurrence in patients with stage II colon cancer, which may help clinicians to determine and perform adjuvant chemotherapy.

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Physicians’ Beliefs About the Benefits and Risks of Adjuvant Therapies for Stage II and Stage III Colorectal Cancer

Cited by 4 publications

References 14 publications

Prognostic Factors and the Role of Adjuvant Chemotherapy in Post-curative Surgery for Dukes B and C Colon Cancers and Survival Outcomes: a Malaysian Experience

Prognostic Factors and the Role of Adjuvant Chemotherapy in Post-curative Surgery for Dukes B and C Colon Cancers and Survival Outcomes: a Malaysian Experience

Is There a Role for Adjuvant Chemotherapy in Rectal Cancer?

A novel prognostic prediction model for recurrence in patients with stage II colon cancer after curative resection.

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