| [ Summary ] |
In Western countries, adjuvant chemotherapy with 5-fluorouracil and folinic acid in combination with oxaliplatin is considered the standard option for patients with Stage III colon cancer. There is still some controversy in regard to indications for adjuvant chemotherapy for Stage II colon cancer. However, the identification of prognostic factors, including those which are clinico-pathological or molecular, may help with the selection of patients who can benefit from adjuvant chemotherapy. Numerous clinical trials are now focusing on the role of molecular targeted agents such as bevacizumab and cetuximab. In regard to rectal cancer, local recurrence is an important factor in determining the outcome for patients after curative surgery. Multidisciplinary management in combination with radiotherapy has been created to reduce local recurrence rates. Randomized controlled trials have shown that radiotherapy combined with mesorectal excision can reduce local recurrence rates in cancer patients who have had radical resections. In western countries, preoperative chemoradiotherapy is now considered to be the standard for management of Stage II/III rectal cancer. In Japan, adjuvant therapy after curative resection of colorectal tumors has been developed using oral fluoropyrimidines. In relation to adjuvant chemotherapy, the National Surgical Adjuvant Study of Colorectal Cancer 01 trial (NSASCC 01) showed that Stage III rectal cancer patients who received uracil and tegafur had significantly prolonged relapse-free survival times and improved overall survival times compared to patients who received surgery alone. However, in Japan the effectiveness of adjuvant chemotherapy for patients with Stage III colon cancer has not been demonstrated. |