Risk-adapted adjuvant treatment of colon cancer

Adjuvant treatment of colon cancer is recommended according to the initial UICC stage of the disease and certain risk factors. If lymph nodes are afflicted (UICC stage III) combination chemotherapy with oxaliplatin and fluoropyrimidines (5-FU or capecitabine) should be administered (evidence level 1a, recommendation level A) following data from the French MOSAIC study. If patients do not qualify for combination treatment monotherapy with fluoropyrimidines should be given preferably with capecitabine. In UICC stage II cancer the recommendation for adjuvant therapy depends on the presence of certain risk factors such as T4 category, emergency surgery, perforation and insufficient lymph nodes examined (less than 12), and patients should then receive adjuvant chemotherapy with fluoropyrimidines. However, none of these risk factors have been validated prospectively and the predictive value is unclear. Oxaliplatin should not be added in stage II cancer. If patients are diagnosed with stage II cancer without risk factors then fluoropyrimidines may be given according to the results of the QUASAR study. In contrast, the ASCO guidelines do not recommend chemotherapy for stage II patients without risk factors.