We appreciate the interest in our article1 by Drs. Betge, Rehak, and Langner. Their letter is a microcosm of the great worldwide interest in defining the role for adjuvant chemotherapy in patients with American Joint Committee on Cancer (AJCC) stage II colon cancer. Although we could not identify specific factors that could be used to select patients for adjuvant chemotherapy, our results nevertheless demonstrate a survival benefit in patients who receive it. The important issue of patient selection is raised by Betge et al. In our article, we referred to current National Comprehensive Cancer Network guidelines, which suggest that lymph node number and poor prognostic indicators (eg, T4 tumor depth and lymphovascular invasion) must be taken into account when considering adjuvant chemotherapy for these patients.1, 2

Betge et al noted that the patients in our cohort who received chemotherapy were more likely to have ≥12 lymph nodes examined. This association is interesting and perhaps counterintuitive given current guidelines to consider adjuvant chemotherapy for patients who have <12 lymph nodes examined. What this may suggest is that no single factor alone dictates the administration of adjuvant chemotherapy for patients with stage II disease in current clinical practice. Several different factors (eg, T classification, number of lymph nodes, lymphovascular invasion, and others) must be considered, as Betge et al demonstrate.3 Taken together, our collective findings indicate that clinicians must continue to use their best judgment in selecting patients to receive adjuvant therapy for stage II colon cancer.


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  • 1
    McKenzie S, Nelson R, Mailey B, et al. Adjuvant chemotherapy improves survival in patients with American Joint Committee on Cancer stage II colon cancer [published online ahead of print June 20, 2011]. Cancer. 2011.
  • 2
    Engstrom PF, Arnoletti JP, Benson AB 3rd, et al.; National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: colon cancer. J Natl Compr Canc Netw. 2009; 7: 778-831.
  • 3
    Betge J, Pollheimer MJ, Lindtner RA, et al. Intramural and extramural vascular invasion in colorectal cancer—prognostic significance and quality of pathology reporting [published online ahead of print July 12, 2011]. Cancer. 2011.