Single-institution experience of adjuvant 5-fluorouracil-based chemotherapy for stage III colon cancer

Adjuvant 5-flourouracil-based chemotherapy is standard care for patients with stage III colon cancer. Limited data are available regarding use of adjuvant treatment in routine clinical practice, where patients are often frail and/or elderly.

A review of patients with stage III colon cancer over a 7-year period at Western Hospital using a prospective, comprehensive colorectal database was carried out. Results were compared to recent clinical trial data.

We identified 554 patients with colon cancer, including 165 patients (30%) with stage III disease. Median patient age was 69 years, with a median follow up of 38 months. There were nine early postoperative deaths. Thirty other patients (19%) were not offered adjuvant chemotherapy, mainly because of advanced patient age and/or comorbidity. Of 124 patients offered adjuvant therapy 12 (10%) elected not to pursue treatment. Thirty-four of the 112 patients that commenced treatment had a dose reduction, with 30 not completing treatment because of toxicity (14) or other reasons (16). The 5-year progression-free survival was 50% and 5-year overall survival 59%.

In routine practice many patients with stage III colon cancer do not receive adjuvant chemotherapy. For those receiving treatment the experience is not significantly different from that reported in the carefully selected clinical trial group.