Adjuvant chemotherapy after resection of the primary tumour reduces the risk of death by an absolute 5% in UICC (Union Internationale Contre le Cancer) stage II colon cancer and about 15–20% in stage III. Adjuvant treatment has to be evaluated separately for each stage due to the different clinical situations: in stage II about 80% of patients are cured by surgery alone, whereas only about half of patients with stage III are cured by surgery. Decisions on adjuvant treatment need to be discussed with the patient on an individual basis, and take into account patient characteristics (performance status, age, co-morbidity and patient preference) as well as cancer features (pathological stage, grading and overall risk of relapse).
Recently, capecitabine in combination with oxaliplatin has been approved for treatment of stage III colon cancer, providing the benefits of an oral fluoropyrimidine. Predictive markers for guidance of treatment have gained importance, particularly in stage II disease. Microsatellite instability, a well known prognostic factor, might be predictive for a lack of activity of fluorouracil treatment in some stage II patients. Furthermore, patients aged ≥70 years do not seem to obtain the same benefit from combination therapy compared with those aged <70 years. The impact of these current developments on daily clinical practice is discussed in this review.