NCCN Guidelines for Patients® | Colon Cancer - page 64

64
NCCN Guidelines for Patients™: Colon Cancer
Version 1.2012
Part 7: A step-by-step treatment guide
7.6.2 Metastases fit for surgery
If prior chemotherapy:
• Systemic treatment, or
• Observation
Primary
treatment
Adjuvant
treatment
Surgical
removal of
metastases
Neoadjuvant
treatment
No treatment
If no prior chemotherapy:
▪ FOLFOX (preferred),
▪ FLOX,
▪ CapeOX,
▪ Capecitabine, or
▪ 5-FU/LV
Systemic
treatment for
advanced cancer
For systemic treatment, see Part 7.7.
For follow-up tests, see Part 7.5.
Surgical
removal of
metastases
If no cancer growth:
• Repeat neoadjuvant
regimen, or
• FOLFOX
If cancer growth:
• Systemic treatment, or
• Observation
7.6.2 Metastases fit for surgery
Primary treatment for metachronous
metastases is surgery to remove metastases.
A colectomy isn’t given. Chemotherapy may
be given before or after surgery or at both
times. Together, neoadjuvant and adjuvant
chemotherapy should not exceed 6 months.
See
Principles of systemic therapy
on page
58 for more information.
When not given neoadjuvant drugs, your
choices for adjuvant treatment are based
on if you’ve had chemotherapy before. If
you haven’t, chemotherapy alone is given.
If you have had chemotherapy before,
chemotherapy with or without targeted
therapy is an option. The other option is not
to have more treatment.
When given neoadjuvant drugs, your choices
for adjuvant treatment are based on if your
cancer grows. If your cancer doesn’t grow,
either start taking the neoadjuvant drugs
again or try FOLFOX alone. If your cancer
does grow, your choices are systemic
treatment or no treatment.
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