Stage 2B (iiB) and Optional Chemo - Very interesting.

PGLGreg said:

confusing
That's "adjuvant", not "adjacent". It is confusing, and apparently not just to us patients, but also confusing to the pros. As I understand it, comparison to other stages suggests that chemo should be beneficial for stage 2 patients, but it has been hard to find direct evidence that this is actually true. As a practical matter, patients might (in my inexpert and uninformed opinion) look for some sort of compromise -- a chemo regimen with relative mild side effects. For stage 2a rectal cancer, I had 10 injections of 5FU + leucovorin. Maybe Denny could run that idea past his oncologist and see what he thinks about something along those lines.

--Greg

PGLGreg said:

I haven't found the reference you cite, so could you give a web reference?

Here is the summary of evidence of benefit for adjuvant treatment of stage 2 cr cancer in Adjuvant Treatment of Colorectal Cancer (2007).:

No single randomized clinical trial has demonstrated a survival benefit for adjuvant therapy in patients with Stage II colon cancer. Subset analyses of trials that have included patients with Stage II and III disease have also repeatedly failed to demonstrate a statistically significant survival benefit for Stage II patients. A pooled analysis of 7 studies demonstrated a 5-year overall survival of 81% in patients who received fluorouracil-based adjuvant therapy and 80% in patients who underwent surgery alone (P = 0.11).65

Two published reports have been cited as favoring the administration of adjuvant therapy in Stage II disease. A retrospective subset analysis of four consecutive National Surgical Adjuvant Breast and Bowel Project (NSABP) trials noted a similar proportional survival benefit for Stage II and Stage III patients who received fluorouracil-based therapy, leading the authors to recommend adjuvant treatment for patients with both Stage II and III colon cancer.91 Results from the Quick and Simple and Reliable (QUASAR) study, a complex comparison of four different fluorouracil-based regimens with observation alone in a heterogeneous patient population, support a marginal survival benefit for patients with Stage II colon and rectal cancer; these results have thus far been reported only in abstract form.92

After systematically reviewing the available literature, the Cancer Care Ontario Program in Evidence-Based Care,93 an expert panel convened by the American Society of Clinical Oncology (ASCO),94 and the National Comprehensive Cancer Network (NCCN)95 independently recommended against the routine administration of adjuvant therapy in patients with Stage II disease. In addition, the ASCO panel determined that a sample size of 9,680 patients per group would be required to detect a 2% survival difference between treatment and control arms (90% power with a significance level of 0.05).94

It has been proposed that adjuvant chemotherapy may benefit patients with Stage II disease and T4 tumor stage, bowel perforation, or clinical bowel obstruction.94 Although this hypothesis has not been validated in a prospective, randomized clinical trial, a retrospective subset analysis of 318 patients with Stage II disease enrolled in the ECOG INT-0035 study of fluorouracil and levamisole suggested a survival benefit for adjuvant therapy in these patient subgroups.25 Although other high-risk features, such as inadequate lymph node sampling, lymphovascular or perineural invasion, poorly differentiated histology, microsatellite stability, and loss of heterozygosity at chromosome 18q, are also known to carry a higher risk of recurrence,18 the potential benefit of chemotherapy is not known in patients with these factors.

PGLGreg said:

Thanks, I found it.
But since adjuvant chemotherapy worsened outcomes for stage IIB patients relative to stage IIIA, it's hard to see here any evidence favoring adjuvant treatment for stage IIB.

--Greg