Adjuvant therapy of stage II colorectal cancer - who will benefit from treatment?

Adjuvant treatment of stage II colon cancer remains an issue of controversy. Though there is evidence indicating that adjuvant therapy is associated with a limited survival benefit, large clinical trials published so far did not provide enough evidence to regard adjuvant therapy of stage II colon cancer as standard of care. The ultimate clinical decision should be based on the presence of high-risk prognostic features, the evidence supporting treatment, the anticipated side effects and morbidity of treatment as well as patient preferences. Considering all these circumstances, regimen containing oxaliplatin together with 5-FU/leukovorin may be regarded as standard therapy. Stage II rectal cancer represents an excellent example for the need of close collaboration between both surgeons and medical oncologists together with radiation oncologists. The combination of radiotherapy and chemotherapy given in the neoadjuvant or adjuvant setting can be regarded as standard therapy. The potential benefit of the addition of oxaliplatin is currently under investigation. The goal of ongoing studies is to investigate whether combination of chemotherapy with therapeutic antibodies such as cetuximab or bevacizumab will become standard of care in the adjuvant setting.