Note: Updated adjuvant therapy information for stage II and III colorectal cancer will be available in early 2009.
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On the basis of accumulated evidence from clinical trials, a 1990 NIH Consensus Development Conference recommended that patients with stage III colon cancer be given adjuvant chemotherapy. The 1990 NIH Consensus Conference also recommended combined adjuvant chemotherapy and high-dose external-beam radiotherapy for stage II and III rectal cancer. Radiation does not appear to affect disease-specific or overall survival for rectal cancer, although it does decrease local recurrence.
Percent of individuals, ages 20 and over, diagnosed with stage III colon cancer who received 5-FU plus either levamisole or leucovorin or diagnosed with stage II or stage III rectal cancer who received 5-FU with or without radiotherapy.
In 2000, 57 percent of stage III colon, and stage II and III rectal patients ages 20 and older received adjuvant chemotherapy.
There are no Healthy People 2010 targets for cancer treatment including for colorectal cancer treatment.
Studies have found that older colorectal patients are less likely to receive adjuvant chemotherapy treatment, even after adjustment for the higher rate of pre-existing co-morbid conditions among older patients. Even elderly patients with no or very few co-morbid conditions, such as diabetes, kidney, or heart disease, were less likely to receive treatment. Earlier studies indicated that Black patients were less likely to receive treatment than White patients; however, this disparity was not found in the 2000 NCI Patterns of Care/Quality of Care study.
Chemotherapy for colorectal cancer is a rapidly evolving field. Emerging treatments include chemotherapy regimens that incorporate irinotecan and/or oxaliplatin agents that interfere with DNA synthesis during cancer cell division and, more recently, anti-angiogenesis agents. These newer drugs result in better outcomes for many colorectal cancer patients but they also are much more expensive than earlier treatments.