Adjuvant Chemotherapy for Colon Cancer
Colon cancer is curable by surgery, but frequently recurs despite apparently complete surgical resection. The risk of such recurrence is closely linked to pathological stage. The concept of adjuvant chemotherapy was conceived many years ago as a way of eradicating microscopic residual disease, and proven by randomized clinical trials in colon cancer in the 1980s. Since that time, many important trials have been completed, and both our understanding of and armamentarium against locoregionally confined colon cancer have improved as a result. Despite this, certain aspects of adjuvant therapy remain controversial, particularly the use of adjuvant therapy in patients with node-negative colon cancer. In this chapter we review the studies that proved adjuvant 5-FU-based therapy effective, discuss controversies in adjuvant therapy, review recent trials with additional agents, and finally discuss the potential for molecular markers to augment stage in determining risk and response to therapy.
