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Colon Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage III Colon Cancer Treatment

Stage III colon cancer denotes lymph node involvement. Studies have indicated that the number of lymph nodes involved affects prognosis; patients with one to three involved nodes have a significantly better survival than those with four or more involved nodes.

Standard Treatment Options for Stage III Colon Cancer

Standard treatment options for stage III colon cancer include the following:

  1. Surgery.
  2. Adjuvant chemotherapy.

Surgery

Surgery for stage III colon cancer is wide surgical resection and anastomosis.

Evidence (laparoscopic techniques):

The role of laparoscopic techniques [1,2,3,4] in the treatment of colon cancer was examined in a multicenter, prospective, randomized trial (NCCTG-934653, now closed) comparing laparoscopic-assisted colectomy (LAC) with open colectomy.

  • Three-year recurrence rates and 3-year overall survival (OS) rates were similar in the two groups. (Refer to the Primary Surgical Therapy section in the Treatment Option Overview section of this summary for more information.)
  • The quality-of-life component of this trial has been published and minimal short-term quality-of-life benefits with LAC were reported.[5][Level of evidence: 1iiC]

Adjuvant chemotherapy

Drug combinations described in this section include the following:

  • The FOLFOX4 regimen (oxaliplatin, leucovorin, and fluorouracil [5-FU]):
    • Oxaliplatin (85 mg/m2) administered as a 2-hour infusion on day 1; leucovorin (200 mg/m2) administered as a 2-hour infusion on day 1 and day 2; followed by a loading dose of 5-FU (400 mg/m2) intravenous bolus, then 5-FU (600 mg/m2) administered via ambulatory pump for a period of 22 hours on day 1 and day 2 every 2 weeks.
  • The Levamisole regimen (5-FU and levamisole):
    • Bolus 5-FU (450 mg/m2 per day) on days 1 to 5, then weekly 28 days later plus levamisole (50 mg) administered orally 3 times a day for 3 days every 2 weeks.
  • The Mayo Clinic or North Central Cancer Treatment Group (NCCTG) regimen (5-FU and low-dose leucovorin):
    • Bolus 5-FU (450 mg/m2)-leucovorin (20 mg/m2) administered daily for 5 days every 28 days.
  • The Roswell Park or National Surgical Adjuvant Breast and Bowel Project (NSABP) regimen (5-FU and high-dose leucovorin):
    • Bolus 5-FU (500 mg/m2)-leucovorin (500 mg/m2) administered weekly for 6 consecutive weeks every 8 weeks.
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