Adjuvant chemotherapy in colon cancer. About 119 cases

##plugins.themes.academic_pro.article.sidebar##

Published Aug 21, 2015
Download
pdf
Vol. 93 No. 4 (2015): Issue Apr 2015

##plugins.themes.academic_pro.article.main##

Asma Yaich
Afef Khanfir
Mohamed Issam Bayrouti
Mounir Frikha

Abstract

Background:colon cancer is a public health problem worldwide and in Tunisia. The prognosis of patients with unresectable colorectal cancer varies according to the stage. The indication for adjuvant chemotherapy is well established in the colon cancer stage III, while it remains a matter of controversy for stage II.
The aim of this work is to identify the epidemiological and anatomoclinical assess therapeutic outcomes in terms of overall survival of patients with high-risk stage II and stage III colon cancer treated with surgery and adjuvant chemotherapy.
Methods : DS: It’s a retrospective study based on 119 patients with colon adenocarcinoma from 1996 to 2010. This patients suffering from colon cancer classified stage II and III having them all radical surgery and adjuvant chemotherapy. Results: The average age of our patients was 53 years. The surgery was performed in an emergency situation in 53 patients (44%). Stages II and III, respectively, were observed in 47% and 53% of cases. Three regimens of chemotherapy were used: protocol FUFOL (50%), followed by FOLFOX (34%) and the protocol LV5FU2 (16%). Overall survival of patients all stages combined was 73.4% at 5 years. Stage III of the TNM classification (p = 0.03) and the number of cycles of chemotherapy <6 (p=0.02) were a negative prognostic factors influencing overall survival. Patients stage III treated with FOLFOX chemotherapy type had a better survival than those treated with chemotherapy type LV5FU2 or FUFOL with a significant difference (p= 0.05).
Conclusion : Our results are consistent with those in the literature. The prognosis of colon cancer is improving thanks to recent advances that have enabled the integration of new cytogenetic factors in the therapeutic decision.

Keywords:

Colon cancer, adjuvant chimiotherapy, prognosis

##plugins.themes.academic_pro.article.details##

References

  1. Kosmider S, Lipton L.Adjuvant therapies for colorectal cancer. Word J Gastroenterol 2007; 13: 3799-3805.
  2. Viguier J, Bourlier P, Karsenti D, De calan L et Danquechin Dorval E. Encycl Méd Chir, Gastro-entérologie, 9-068-A-10, 2003, 18p
  3. Trabelsi O, Hassair M, Haouet K. Le cancer du colon, étude de 153 cas et comparaison avec une série historique de 140 cas. Tunisie Med 1999; 77 : 621-29
  4. Conférence de Consensus : prévention, dépistage et prise en charge des cancers du colon. Gastroentérol Clin Biol 1998 ; 22 :290-295.
  5. Moertel CG, Fleming TR, Macdonald JS et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med 1990; 322:352-358.
  6. Haller DG, Catalano PJ, Macdonald JS, Mayer RJ. Fluorouracil, leucovorin and levamisol adjuvant therapy for colon cancer: preliminary results of int-0089. Proc Am Soc Clin Oncol 1996; 15:211A.
  7. O'Connell MJ, Laurie JA, Kahn M, Fitzgibbons RJ et al. Prospectively randomised trial of post operative adjuvant chemotherapy in patients with high- risk colon cancer. J Clin Oncol 1998;16:295-300.
  8. Andre T, Colin O, Louvet C et al. Semimonthly versus monthly regimen of fluorouracil and leucovorin administered for 24 or 36 weeks as adjuvant therapy un stage II and III colon cancer : results of a randomized trial. J Clin Oncol 2003; 21:2896-903.
  9. Andre´ T, Boni C, Mounedji-Boudiaf L et al. Oxaliplatin, 5- fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004; 350: 2343-51.
  10. André T, Boni C, Navarro M et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 2009; 27:3109-16.
  11. Yothers G, O'Connell MJ, Allegra CJ et al. Oxaliplatin as adjuvant therapy for colon cancer: updated results of NSABP C-07 trial, including survival and subset analyses.J Clin Oncol. 2011; 29:3768-74.
  12. Mc Cleary J, Meyerhardt J, Green E, et al. Impact of older age on the efficacy of newer adjuvant therapies in >12,500 patients (pts) with stage II/III colon cancer: Findings from the ACCENT Database. J Clin Oncol 2009; 27
  13. Haller D, Tabernero J , Maroun J et al. First efficacy findings from a randomized phase III trial of capecitabine + oxaliplatin vs. bolus 5-FU/LV for stage III colon cancer (NO16968/XELOXA study). European Journal of Cancer 2009; 7(Suppl]): 3
  14. Erlichman C, Marsoni S, Seitz JF et al. International Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) Investigators. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. J Clin Oncol 1999; 17:1356-1363.
  15. Quasar Collaborative Group, Gray R, Barnwell J, McConkey C, Hills RK, Williams NS, Kerr DJ. Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study.The lancet 2007; 370: 2020-2029.
  16. Benson A, Deborah S, Somerfield M et al. ASCO Recommendations on Adjuvant Chemotherapy for Stage II Colon Cancer. Journal of Clinical Oncology 2004; 3408-3419.
  17. Auvinen A, Isola J, Visakorpi T et al. Overxpression of p53 and long-term survival in colon carcinoma. Br J Cancer 1994; 79:316-22
  18. Vermeulen P, Van Den Eynden G, Huget P et al. Prospective study of intratumoral microvessel density, p53 expresion end survival in colorectal cancer. Br J Cancer 1999; 79:316-22.
  19. Ahnen DJ, Feigl P, Quan G et al. Ki-ras mutation and p53 overexpression predict the clinicat behavior of colorectal cancer: a Southwest Oncology Group study.Cancer Res 1998;58: 1149-58.
  20. Kressner U, Inganas M, Byding S et al. Prognostic value of p53 genetic changes in colorectal cancer. J Clin Oncol 1999;17:593-9.
  21. ZaananA, Cuilliere-Dartigues P, Guilloux A et al. Impact of p53 expression and microsatellite instability on stage III colon cancer disease-free survival in patients treated by 5-fluorouracil and leucovorin with or without oxaliplatin. Ann Oncol 2010; 21:772-80.
  22. And reyevHJ , NormanAR, Cunningham D et al. Kirsten ras mutations in patients with colorectal cancer: the'RASCAL ll'study, Br J Cancer 2001 ; 85:692-6.
  23. BleekerWA, HayesVM, Karrenbeld A et al. Impact of KRAS and TP53 mutations on survival in patients with left- and right-sided Dukes'C colon cancer. Am J Gastroenterol 2000;95:2953-7.
  24. Esteller M, Gonzalez S, Risques RA et al. K-ras and p16 aberrations confer poor prognosis in human colorectal cancer. J Clin Oncol 2001 ; 19:299-304.
  25. Popat S, Hubner R, Houlston RS. Systemic review of microsatellite instability and colorectal cancer prognosis. J Clin Oncol 2005;23:609-18.
  26. Ribic CM, Sargent DJ, Moore MJ et al. Tumor microsatelliteinstability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med 2003; 349:247-257
  27. . F. Sinicrope, N. R. Foster, D. J. Sargent et al. DNA mismatch repair status and site of tumor recurrence in stage II and III colon cancers treated in 5-fluorouracil-based adjuvant therapy trials (abstract) . J Clin Oncol 2010; 28(suppl) :15- 3519.
  28. Hutchins G, Southward K, Handley K et al. Value of Mismatch Repair, KRAS, and BRAF Mutations in Predicting Recurrence and Benefits From Chemotherapy in Colorectal Cancer. JCO.2010; 29: 1261-1270
  29. Sargent DJ, Marsoni S, Monges G et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer. J Clin Oncol. 2010; 28:3219-26
  30. Chau l, Cunningham D. Adjuvant therapy in colon cancer what, when and how?. Annals of Oncologie 2006;17:1347-59
  31. Conférence de Consensus. Conclusions et recommandations du jury. Texte de Consensus. Prévention, dépistage et prise en charge des cancers du côlon. Gastroenterol Clin Biol 1998; 22 : S275-88.
  32. Dobie S, Baldwin L, Dominitz J et al. Completion of therapy by medicare patients with stage III colon cancer. J Natl Cancer Inst 2006;98:610-619.