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53

NCCN Guidelines for Patients

®

:

Colon Cancer, Version 1.2017

5

Metastatic disease

Metastases at recurrence

option. However, NCCN experts prefer surgery over

local therapy.

Results of primary treatment should be assessed

with CT with contrast. Scans of your chest, abdomen,

and pelvis are needed. Imaging should be done prior

to adjuvant treatment.

Adjuvant treatment is based on whether you had

chemotherapy before. If not, preferred options

are FOLFOX and CAPEOX. Otherwise, you may

receive capecitabine or 5-FU/LV. Six months of

chemotherapy is preferred.

If you’ve had chemotherapy, observation is an

option. Observation is a period of testing to assess

for cancer growth. Another option is chemotherapy.

Targeted therapy may be added but more research is

needed. Regimens are listed in Part 6. Six months of

chemotherapy is preferred.

Option 2

Option 2 starts with neoadjuvant chemotherapy.

FOLFOX and CAPEOX are preferred regimens.

Otherwise, you may receive capecitabine or 5-FU/LV.

After 2 to 3 months of chemotherapy, you may

receive primary treatment. It may consist of

metastasectomy. Local therapy to the liver or lung

may be added. Local therapy includes ablation

and SBRT. Local therapy without surgery is

Guide 14. Surgical options

Option 1

Primary treatment

Adjuvant treatment

• Metastasectomy ± local treatment

• Local treatment

• No prior chemotherapy

◦◦ FOLFOX or CAPEOX

◦◦ Capecitabine or 5-FU/LV

• Prior chemotherapy

◦◦ Observation

◦◦ Chemotherapy ± targeted therapy in Part 6

Option 2

Neoadjuvant treatment

Primary treatment

Adjuvant treatment

• FOLFOX or CAPEOX

• Capecitabine or 5-FU/LV

• Metastasectomy ± local treatment

• Local treatment

• If neoadjuvant worked:

◦◦ Re-start neoadjuvant regimen

◦◦ FOLFOX

◦◦ Observation

• If neoadjuvant didn’t work:

◦◦ Chemotherapy ± targeted

therapy in Part 6

◦◦ Observation