Adjuvant Therapy for Colorectal Cancer

A high-yield review of the post-operative management of resected stage II and III colorectal cancer. Key topics include the non-negotiable need for adjuvant chemotherapy (chemo) in stage III patients, leveraging landmark trials like MOSAIC. The episode details the paradigm shift in duration: 3 months of CAPOX is now the standard for low-risk stage III disease following the IDEA collaboration, reducing debilitating oxaliplatin toxicity. For stage II, management relies heavily on risk stratification (e.g., T4 tumors, less than 12 nodes harvested) and molecular analysis (MSI/MMR, BRAF status). Also covered are the benefits of Total Neo-adjuvant Therapy (TNT) for rectal cancer and the current controversy surrounding intensive surveillance, which modern trials suggest provides no overall survival benefit.