Adjuvant and palliative chemotherapy of colorectal cancer in Germany outside controlled trials

Background and objective: Colorectal cancer is the second most common malignant tumour in Germany with an unfavorable prognosis especially in a locally advanced or metastasizing stage. Although adjuvant and palliative chemotherapy significantly improve 5-year survival, consensus recommendations have in the past been inadequately transformed into clinical practice. It was the aim of this study to analyse the implementation of existing guidelines in a cohort from a defined area of Germany. Patients and methods: In a multicentre study done between January 2000 and January 2002, tumour stage, primary care, adjuvant or palliative chemotherapy and follow-up of 444 patients (216 males, 228 females) with newly diagnosed colorectal cancer were recorded. Results: 301 patients had colonic and 143 patients rectal cancer. The median age at diagnosis was 65 +/- 11.3 years. 36 of 96 (38%) patients with stage II colon cancer and 66 of 87 (76%) with stage III disease received adjuvant chemotherapy. 8 of 51 (16%) patients with rectal cancer stage II and 22 of 38 (58%) patients with stage III underwent adjuvant radio- and chemotherapy. The 68 of 84 (81%) patients with stage IV CRC who received palliative chemotherapy were given almost exclusively 5-FU monotherapy. Initial or sequential combination chemotherapy with oxaliplatin or irinotecan were performed in only 24 of 84 (29%) patients. Conclusions: Stage III colon cancer was predominantly treated according to the existing standard guidelines. In contrast combined radio- and chemotherapy for rectal cancer stage II and III was only performed in one third of the patients, another third receiving neither adjuvant radiation nor chemotherapy. Initial combined or sequential combined chemotherapy for metastasizing colorectal cancer was rarely performed.