Summary of adjuvant chemo referral

• WHO Performance status 0 or 1

• There will be few exceptions to the performance status rule - example, a
well amputee, who uses a wheelchair.
• Refer if in doubt.
Stage chemo Exception Regime

Stage 1 No R1 resection Depends on fitness.

T1/2 N0 Not supported by guidelines

Stage 2 Weekly 5 Fu(6 months)

T3N0M0- no adverse features
T3/4N0M0- with adverse
features(poorly differentiated
histology, LVI or PvI, obstruction)
Maybe (benefit 2-3%)
Encouraged in younger
patients(benefit likely > 3%)
Loss of mismatch repair proteins
OR
* Elderly patient where chemo for
2-3 % benefit is inappropriate*
3 months Capecitabine/Oxaliplatin
(CAPOX)if no ileostomy.
Weekly IV 5FU( 6 months) or
FOLFOX 3 months if ileostomy

Stage 3
If MMR deficient and not suitable CAPOX for 3 months
Stage 3a YES for combination chemo( single Or Capecitabine 6 months if unfit
agent capecitabine/5FU won’t for combination
work) Or FOLFOX 6 months if has
ileostomy ( variable across the
R1 resection ( treat with 6 months) country-some clinicians would give
3 months)

Stage 3b /c YES As above CAPOX/FOLFOX for 6 months

Or single agent Capecitabine/5FU
for 6 months if unfit

CAPOX: Oxaliplatin (IV) and Capecitabine FOLFOX : 5FU (48hrs infusion given via PICC line ) and Oxaliplatin IV
Stage 3 Survival Chart for discussing chemo benefit