Colorectal Cancer (CRC): Benefits of Adjuvant Chemotherapy for Stage III CRC

Colorectal Cancer (CRC): Benefits of Adjuvant Chemotherapy for Stage III CRC

Adjuvant Treatment

Adjuvant treatment is treatment given after primary treatment (eg. surgery, radiotherapy) to fully eradicate any remaining cancer cells.

Types of adjuvant treatment for cancer are chemotherapy, radiotherapy, hormonal therapy, targeted therapy and biologic therapy. 

Why is Adjuvant Treatment Important?

Even if the surgery was successful at removing all visible tumor, microscopic cancer cells that cannot be seen by surgeon can be missed, especially in more advanced cancer stage.

Screen Shot 2018-08-17 at 10.21.44 PM.png
Disease free survival (DFS) for stage III CRC for multiple clinical trials. Improvement in DFS clearly seen better with combination chemotherapy > monotherapy > no treatment.

In colorectal cancer, adjuvant chemotherapy helped to lower disease recurrence, increase cure rate and survival, especially in more advanced cancer stage.

Screen Shot 2018-08-17 at 10.22.02 PM
Overall survival (OS) for stage III CRC for multiple clinical trials. Improvement in OS also clearly seen better with combination chemotherapy > monotherapy > no treatment. Certain study like MOSAIC even report long-term (10-years) survival data.

Multiple studies showed clear benefit of adjuvant chemotherapy in stage III and also in ‘high-risk’ stage II colorectal cancer.

‘High-risk’ stage II are

  • positive/ close resection margin
  • lymph nodes sampling <12
  • poorly differentiated tumour
  • vascular or lymphatic or perineural invasion
  • tumour presentation with obstruction or tumour perforation
  • pT4 stage

Finally

Adjuvant chemotherapy is not offered to all patients.

It’s only for selected group of colorectal cancer patients (stage III, ‘high-risk’ stage II) who derives most benefit from it based on multiple clinical trials.

I always find it odd that patients dare to undergo surgery for hours to resect the tumor out but are scared of chemotherapy, which is just infusion of medicine.

They should join some support groups and hear from real patients who had successfully completed chemotherapy (most of them tolerate chemotherapy well) instead of basing their perception of chemotherapy from television or from those who have never undergo chemotherapy treatment before.

Unfortunately, a middle-aged patient of mine with stage 3 colorectal cancer still refused adjuvant chemotherapy today despite my hour-plus explanation. Sigh!

Will you refuse six months of adjuvant chemotherapy for CRC if it can allow you to live more than 10-years?

#drbhnglatest

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