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Practice Guideline
. 2009 Dec;106(51-52):843-8.
doi: 10.3238/arztebl.2009.0843. Epub 2009 Dec 18.

Colorectal carcinoma: the management of polyps, (neo)adjuvant therapy, and the treatment of metastases

Wolff Schmiegel  1 , Christian Pox, Dirk Arnold, Rainer Porschen, Claus Rödel, Anke Reinacher-Schick; Association of the Scientific Medical Societies in Germany; German Cancer Aid; German Cancer Society; German Society for Digestive and Metabolic Diseases; German Society for General and Visceral Surgery; German Society for Hematology and Oncology; German Society for Pathology; German Society for Radiooncology; German Roentgen Society; German Joint Society for Clinical Chemistry and Laboratory Medicine; German Society for Coloproctology; Association of Stoma Patients and Persons with Intestinal Cancer; German Crohn's Disease and Ulcerative Colitis Association; German Society for Internal Medicine
Collaborators, Affiliations
Practice Guideline

Colorectal carcinoma: the management of polyps, (neo)adjuvant therapy, and the treatment of metastases

Wolff Schmiegel et al. Dtsch Arztebl Int. 2009 Dec.

Erratum in

  • Dtsch Arztebl Int. 2010 Feb;107(5):74

Abstract

Background: Colorectal carcinoma (CRC) is the second most common type of cancer in Germany. In view of recent major changes in the diagnosis and treatment of CRC, the S3 guideline for CRC published in its full version in 2004 was partially updated in 2008 and again in 2009.

Method: The literature was systematically searched for all articles published from 2004 onward concerning polyp management, (neo-)adjuvant treatment, and treatment of metastatic disease. Evidence-based recommendations were developed in a consensus conference.

Results: For some patients who have undergone polypectomy, the time to follow-up with colonoscopy can be lengthened. In UICC stage III colon cancer, adjuvant chemotherapy with an oxaliplatin-based regimen is recommended. In stage II colon cancer, adjuvant chemotherapy should be considered mainly when risk factors are present. In stages II and III, neo-adjuvant therapy should be given before resection in rectal cancer. In patients with metastatic disease, the use of all possible treatment options results in a median overall survival time of 24 months. In some patients with primarily non-resectable liver metastases, systemic treatment may enable a secondary, potentially curative resection. Therapeutic agents are chosen individually on the basis of clinical factors including the goal of treatment, the patient's general condition, and tumor molecular markers.

Conclusion: The S3 guideline contains evidence-based recommendations for the diagnosis and treatment of colorectal carcinoma. Broad implementation of the guideline will be essential for improved patient care.

Keywords: adjuvant therapy; cancer treatment; colorectal carcinoma; palliative treatment; polyps.

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Figures

Figure
Figure
Flowchart for the systematic literature search; TG = topic group
See this image and copyright information in PMC

Comment in

  • Resistance tests were not mentioned.
    Lippert TH. Lippert TH. Dtsch Arztebl Int. 2010 Jun;107(22):399; author reply 399-400. doi: 10.3238/arztebl.2010.0399a. Epub 2010 Jun 4. Dtsch Arztebl Int. 2010. PMID: 20574557 Free PMC article. No abstract available.

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