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New
method proposed for determining which
patients should get treatment for Colorectal
Cancer
* A new
study being presented at the American
Society of Clinical Oncology meeting in
Chicago (Abstract #4020), may change
treatment practice in about 25 percent of
patients with colon cancer and is the basis
for proposed changes to the way colorectal
cancers will be staged.
* This new study, using National Cancer Institute (NCI)
SEER population-based statistic registries
from 1992 to 2004, and phase III clinical
trial data, shows that outcomes of patients
with positive nodes (Stage III) in
colorectal cancer interact, to a greater
extent than previously thought, with how
deeply the cancer penetrates the bowel wall.
* Survival outcomes depend on the thickness of the
primary cancer within or beyond the bowel
wall in addition to whether nodes are
positive or negative. A patient with a node
positive ‘thin’ lesion (i.e., confined to
the bowel wall) has a stage III cancer with
better survival outcomes than a patient with
a Stage II node negative ‘thick’ cancer that
penetrates beyond the bowel wall. The
current standard of practice for colon
cancer patients is that all or most Stage
III patients receive chemotherapy after
surgical removal of their cancer, but Stage
II patients do not routinely receive
chemotherapy. In a separate National Cancer
Data Base (NCDB) analysis, patients with
Stage III colon cancers confined to the
bowel wall who did not receive chemotherapy
still had better survival than Stage II
patients.
* Guidelines for adjuvant therapy may need
re-examination in future clinical trials as
well as more research into the molecular
basis for the interplay between a primary
cancer's ability to penetrate the bowel wall
and to spread to regional nodes.
* Also, the survival of patients whose cancers invade
beyond the bowel wall to involve adjacent
structures or organs is worse than that of
patients whose cancers merely penetrate to
the surface of the bowel wall (the reverse
had been thought to be true).
* This abstract/poster will be presented by Dr. Leonard
L. Gunderson, M.D., a radiation oncologist
from Mayo Clinic, Scottsdale, Ariz., and
Vice Chair of the Hindgut Task Force of the
American Joint Commission on Cancer (AJCC)
that proposes changes to current guidelines.
J. Milburn Jessup, M.D., NCI, part of the
National Institutes of Health, is the chair
of the Task Force.
Quotes:
* J. Milburn Jessup, M.D.: “These proposed changes could
lead to real clinical benefit for many
colorectal cancer patients and also lessen
the amount of treatment that patients with
thin lesions may need.”
* John E. Niederhuber, M.D., Director, NCI: “Simple
advances in treatment that are derived by
comparing national statistics to clinical
data are greatly welcomed and are an
excellent example of moving the field
forward by some basic, low-cost methods.”
* Leonard L. Gunderson, M.D.: “The current SEER analysis
confirms that patients with node positive
colon or rectal cancers that do not extend
beyond the bowel wall have better survival
than previously thought.”
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