title: American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer.
abstract: OBJECTIVE
  To address whether all medically fit patients with curatively resected stage II colon cancer should be offered adjuvant chemotherapy as part of routine clinical practice, to identify patients with poor prognosis characteristics, and to describe strategies for oncologists to use to discuss adjuvant chemotherapy in practice.
  
  
  METHODS
  An American Society of Clinical Oncology Panel, in collaboration with the Cancer Care Ontario Practice Guideline Initiative, reviewed pertinent information from the literature through May 2003.
  
  
  RESULTS
  A literature-based meta-analysis found no evidence of a statistically significant survival benefit of adjuvant chemotherapy for stage II patients. Recommendations The routine use of adjuvant chemotherapy for medically fit patients with stage II colon cancer is not recommended. However, there are populations of patients with stage II disease that could be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology.
  
  
  CONCLUSIONS
  Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer. Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease. The ultimate clinical decision should be based on discussions with the patient about the nature of the evidence supporting treatment, the anticipated morbidity of treatment, the presence of high-risk prognostic features on individual prognosis, and patient preferences. Patients with stage II disease should be encouraged to participate in randomized trials.
authors.affiliation: American Society of Clinical Oncology, Alexandria, VA 22314, USA. guidelines@asco.org
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Mark R
authors.initials: MR
authors.lastname: Somerfield
authors.forename: Alfred M
authors.initials: AM
authors.lastname: Cohen
authors.forename: Alvaro T
authors.initials: AT
authors.lastname: Figueredo
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Flynn
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.forename: Jean
authors.initials: J
authors.lastname: Maroun
authors.forename: Pamela
authors.initials: P
authors.lastname: McAllister
authors.forename: Eric
authors.initials: E
authors.lastname: Van Cutsem
authors.forename: Melissa
authors.initials: M
authors.lastname: Brouwers
authors.forename: Manya
authors.initials: M
authors.lastname: Charette
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Haller
mesh_terms: D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis