title: Adjuvant systemic chemotherapy for stages II and III colon cancer after complete resection: a clinical practice guideline.
abstract: BACKGROUND
  Updated practice guidelines on adjuvant chemotherapy for completely resected colon cancer are lacking. In 2008, Cancer Care Ontario's Program in Evidence-Based Care developed a guideline on adjuvant therapy for stages ii and iii colon cancer. With newer regimens being assessed in this patient population and older agents being either abandoned because of non-effectiveness or replaced by agents that are more efficacious, a full update of the original guideline was undertaken.
  
  
  METHODS
  Literature searches (January 1987 to August 2015) of medline, embase, and the Cochrane Library were conducted; in addition, abstracts from the American Society of Clinical Oncology, the European Society for Medical Oncology, and the European Cancer Congress were reviewed (the latter for January 2007 to August 2015). A practice guideline was drafted that was then scrutinized by internal and external reviewers whose comments were incorporated into the final guideline.
  
  
  RESULTS
  Twenty-six unique reports of eighteen randomized controlled trials and thirteen unique reports of twelve meta-analyses or pooled analyses were included in the evidence base. The 5 recommendations developed included 3 for stage ii colon cancer and 2 for stage iii colon cancer.
  
  
  CONCLUSIONS
  Patients with completely resected stage iii colon cancer should be offered adjuvant 5-fluorouracil (5fu)-based chemotherapy with or without oxaliplatin (based on definitive data for improvements in survival and disease-free survival). Patients with resected stage ii colon cancer without "high-risk" features should not receive adjuvant chemotherapy. For patients with "high-risk" features, 5fu-based chemotherapy with or without oxaliplatin should be offered, although no clinical trials have been conducted to conclusively demonstrate the same benefits seen in stage iii colon cancer.
authors.affiliation: Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, ON.
authors.forename: B M
authors.initials: BM
authors.lastname: Meyers
authors.affiliation: Program in Evidence-Based Care, Department of Oncology, McMaster University, Juravinski Campus, Hamilton, ON.
authors.forename: R
authors.initials: R
authors.lastname: Cosby
authors.affiliation: Toronto Western Hospital, Toronto, ON.
authors.forename: F
authors.initials: F
authors.lastname: Quereshy
authors.affiliation: The Ottawa Hospital Cancer Centre, Ottawa, ON.
authors.forename: D
authors.initials: D
authors.lastname: Jonker
keywords: Adjuvant treatment; chemotherapy; colon cancer; practice guidelines