The presence of more than one risk factor may increase the risk of recurrence 9 in an exploratory analysis of International Duration Evaluation of Adjuvant Chemotherapy (IDEA) collaboration data, the 5-year disease-free survival (DFS) was 74.8% for stage II patients with two or more risk factors, compared with 87.3% for patients with one risk factor. The number of risk factors should be considered as part of the shared decision-making process. Duration of oxaliplatin-containing chemotherapy is also addressed, with recommendations for 3 or 6 months of treatment with capecitabine and oxaliplatin or fluorouracil, leucovorin, and oxaliplatin, with decision making informed by key evidence of 5-year disease-free survival in each treatment subgroup and the rate of adverse events, including peripheral neuropathy.Īdditional information is available at Recommendation 1.4.ĪCT may be offered to patients with stage IIA (ie, T3) colon cancer with high-risk features, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, and/or grade BD3 tumor budding (≥ 10 buds) (Type: Evidence-based benefits may outweigh harms Evidence quality: low Strength of recommendation: weak). Patients with mismatch repair deficiency/microsatellite instability tumors should not be routinely offered ACT if the combination of mismatch repair deficiency/microsatellite instability and high-risk factors results in a decision to offer ACT, oxaliplatin-containing chemotherapy is recommended.

The addition of oxaliplatin to fluoropyrimidine-based ACT is not routinely recommended, but may be offered as a result of shared decision making.

Patients with T4 tumors are at higher risk of recurrence and should be offered ACT, whereas patients with other high-risk factors, including sampling of fewer than 12 lymph nodes in the surgical specimen, perineural or lymphovascular invasion, poorly or undifferentiated tumor grade, intestinal obstruction, tumor perforation, or grade BD3 tumor budding, may be offered ACT.

Adjuvant chemotherapy (ACT) is not routinely recommended for patients with stage II colon cancer who are not in a high-risk subgroup.

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