Background: Standard protocols for adjuvant chemotherapy of stage III colon cancer have been defined in randomised phase III studies. The literature suggests arbitrary dose reductions are common in routine clinical practice, even when treatment is with curative intent. Since 2002 we have used standard BSA based treatment protocols at two hospitals, with the treating clinician having to justify any deviation from these. Here we report the reason for and frequency of deviations, subsequent dose reductions and completion rates, and survival outcomes.  

Methods: Review of data from a comprehensive prospective colorectal cancer database at Royal Melbourne and Western Hospital. All patients were managed in a colorectal cancer clinic by medical oncologists with a GI subspecialty interest.

Results: 932 patients with stage III colon cancer were identified, median age was 67.5 years, 503 (54%) were male. 652 patients (70%) had received adjuvant chemotherapy, median age 64.3 years, 284 (43.6%) with oxaliplatin based treatment, the remainder with a fluoropyrimidine alone. 34 patients (5.2%) had an initial dose reduction, including 15 of 108 (14%) of patients aged 75 years or older, and 10 of 119 (8.4%) who were overweight or obese. 304 (46.6%) had a subsequent dose reduction, with no impact of age or BMI.  466 patients (71.5%) completed planned treatment. Survival data are being examined.

Conclusions: Rates of adjuvant chemotherapy delivery are similar to previous reports. Standard BSA based chemotherapy dosing appears deliverable in routine clinical practice. Subset analyses by treatment are planned, along with comparisons with reported rates of dose reductions, completion rates and survival data in clinical trials.

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