The above patient (of Q. no. 25) undergoes surgery and recovers uneventfully. Pathology of the resected specimen is reported as Dukes C with negative surgical margins. Best post operative management plan is?
|A||External beam irradiation|
|B||5-fluorouracil and leucovorin|
|C||External beam irradiation and chemotherapy|
|D||No further treatment|
a. Postoperative treatment of patients with stage II colon cancer is somewhat controversial.
b. The 5-year survival rate of patients with stage IIA disease is 85%, compared with 72% for stage IIB disease, which is actually worse than for those patients with node-positive stage IIIA disease.
c. Whether oxaliplatin-based regimens should be used in stage II disease in addition to 5-FU/leucovorin is controversial, but current practice in most areas appears to favor the addition of oxaliplatin in early-stage disease.
d. Further follow-up of stage II patients includes a CEA level every 3 months for 2 years, then every 6 months for a total of 5 years, and yearly CT scans of the abdomen and chest for at least the first 3 years.
e. Patients with stage III disease clearly benefit from adjuvant chemotherapy.
f. The addition of oxaliplatin to the 5-FU/leucovorin regimen (FOLFOX) has resulted in an improvement of disease-free survival rates at 3 years to 78% (compared with 73% with 5-FU/leucovorin alone).
g. Irinotecan (Camptosar) has been investigated as an addition to 5-FU–based therapy in the adjuvant setting, based on its benefit against metastatic disease.