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Adjuvant Chemotherapy for Stage III Colon Cancer
Review

Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?

1
Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden
2
Department of Surgery, Gävle Hospital, 801 87 Gävle, Sweden
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(11), 3308; https://doi.org/10.3390/cancers12113308
Received: 15 September 2020 / Revised: 27 October 2020 / Accepted: 6 November 2020 / Published: 9 November 2020
(This article belongs to the Special Issue Adjuvant Chemotherapy for Colorectal Cancer)
Evidence indicates that recurrence risk after colon cancer today is less than it was when trials performed decades ago showed that adjuvant chemotherapy reduces the risk and prolong disease-free and overall survival. After rectal cancer surgery, local recurrence rates have decreased but it is unclear if systemic recurrences have. After a systematic review of available literature reporting recurrence risks after curative colorectal cancer surgery we report that the risks are lower today than they were in the past and that this risk reduction is not solely ascribed to the use of adjuvant therapy. Adjuvant therapy always means overtreatment of many patients, already cured by the surgery. Fewer recurrences mean that progress in the care of these patients has happened but also that the present guidelines giving recommendations based upon old data must be adjusted. The relative gains from adding chemotherapy are not altered, but the absolute number of patients gaining is less.
Adjuvant chemotherapy aims at eradicating tumour cells sometimes present after radical surgery for a colorectal cancer (CRC) and thereby diminish the recurrence rate and prolong time to recurrence (TTR). Remaining tumour cells will lead to recurrent disease that is usually fatal. Adjuvant therapy is administered based upon the estimated recurrence risk, which in turn defines the need for this treatment. This systematic overview aims at describing whether the need has decreased since trials showing that adjuvant chemotherapy provides benefits in colon cancer were performed decades ago. Thanks to other improvements than the administration of adjuvant chemotherapy, such as better staging, improved surgery, the use of radiotherapy and more careful pathology, recurrence risks have decreased. Methodological difficulties including intertrial comparisons decades apart and the present selective use of adjuvant therapy prevent an accurate estimate of the magnitude of the decreased need. Furthermore, most trials do not report recurrence rates or TTR, only disease-free and overall survival (DFS/OS). Fewer colon cancer patients, particularly in stage II but also in stage III, today display a sufficient need for adjuvant treatment considering the burden of treatment, especially when oxaliplatin is added. In rectal cancer, neo-adjuvant treatment will be increasingly used, diminishing the need for adjuvant treatment. View Full-Text
Keywords: colorectal cancer; colon cancer; rectal cancer; chemotherapy; adjuvant treatment; recurrence risk; systematic overview colorectal cancer; colon cancer; rectal cancer; chemotherapy; adjuvant treatment; recurrence risk; systematic overview
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MDPI and ACS Style

Osterman, E.; Hammarström, K.; Imam, I.; Osterlund, E.; Sjöblom, T.; Glimelius, B. Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It? Cancers 2020, 12, 3308. https://doi.org/10.3390/cancers12113308

AMA Style

Osterman E, Hammarström K, Imam I, Osterlund E, Sjöblom T, Glimelius B. Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It? Cancers. 2020; 12(11):3308. https://doi.org/10.3390/cancers12113308

Chicago/Turabian Style

Osterman, Erik, Klara Hammarström, Israa Imam, Emerik Osterlund, Tobias Sjöblom, and Bengt Glimelius. 2020. "Recurrence Risk after Radical Colorectal Cancer Surgery—Less Than before, But How High Is It?" Cancers 12, no. 11: 3308. https://doi.org/10.3390/cancers12113308

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