From the Guidelines
Patientem cum cancro sigmae stadio IIIB, qui 8 cyclis XELOX (oxaliplatini et capecitabini) post resectionem completis, ab tractatione debere finiri et ad observationem sequendam transire oportet. Hic patientem standardem durationem chemiotherapiae adiuvantis pro cancro colonis stadio III completavit, et continuare ultra 8 cyclis non monstratum est beneficium additionale survivalis et potest auctum risicum toxicitatum cumulativarum, particulariter neuropathiae periphericae oxaliplatino-inductae, quae potest permanentem fieri. Observatio sequenda debet includere visitas clinicas regulares omni 3-6 mensibus pro primis 2-3 annis, deinde omni 6 mensibus usque ad annum 5, cum examinatione CEA, scan CT thoracis/abdominis/pelvis, et colonoscopia (primo anno post chirurgiam, deinde omni 3-5 annis si normalis). Haec schedula observationis permittit detectionem praecocem recidivae, dum aequilibrit risicos et impendia examinationum excessivarum. Tempus observationis criticissimum est primi 2-3 anni post tractationem, cum maximo risico recidivae 1.
- Visita clinica regularis omni 3-6 mensibus pro primis 2-3 annis
- Examinatio CEA omni 3-6 mensibus pro primis 2-3 annis
- Scan CT thoracis/abdominis/pelvis omni 6 mensibus pro primis 3 annis
- Colonoscopia primo anno post chirurgiam, deinde omni 3-5 annis si normalis
- Visita clinica regularis omni 6 mensibus usque ad annum 5
Haec schedula observationis sequendae est secundum recommendationes ASCO pro cancro colonis stadio III, et debet adaptari ad singulos patientes secundum necessitates et praefecturas eorum 1.
From the Research
Patient Status Post Resectionem Sigmae
- Patient has completed 8 cycles of XELOX (oxaliplatin and capecitabine) post-resection for stage IIIB sigmoid cancer.
- The patient's treatment regimen is consistent with standard adjuvant therapy for patients with stage III colon cancer, as supported by studies such as 2 and 3.
Treatment Efficacy and Toxicity
- The study by 2 found that a modified XELOX regimen with 6 cycles of oxaliplatin and a full cycle of capecitabine had comparable disease-free survival (DFS) and overall survival (OS) rates to the standard XELOX regimen, but with lower incidence of neurotoxicity, leucopenia, and thrombocytopenia.
- The study by 3 demonstrated that XELOX adjuvant therapy improved DFS in patients with stage III colon cancer, with a 3-year DFS rate of 70.9% compared to 66.5% with fluorouracil and folinic acid (FU/FA) therapy.
Feasibility of XELOX Without Central Venous Access Device
- The study by 4 found that XELOX chemotherapy without a central venous access device (CVAD) was feasible for 81.2% of patients with stage III colon cancer, with similar oxaliplatin doses and no significant differences in chemotherapy duration.
Personalizing Adjuvant Therapy
- The study by 5 highlighted the importance of personalizing adjuvant therapy for patients with colorectal cancer, using genetic analyses, artificial intelligence-driven models, and liquid biopsy approaches to identify patients at high and low risk of tumor recurrence.
- The study by 6 reported a case of long-term survival in a patient with perforated sigmoid cancer and simultaneous liver metastasis after multidisciplinary treatment, including adjuvant chemotherapy and surgical interventions.
Next Steps
- Considering the patient has completed 8 cycles of XELOX, it may be reasonable to end treatment and follow up, as the standard treatment duration is typically 6 months 3.
- However, the decision to end treatment should be based on individual patient factors, including tumor response, toxicity, and overall health status, as well as consideration of potential benefits and risks of continued therapy 2, 5.