Novel genetic and epigenetic alterations in ... - Ous-research.no
Novel genetic and epigenetic alterations in ... - Ous-research.no
Novel genetic and epigenetic alterations in ... - Ous-research.no
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IntroductionFigure 12. Present <strong>and</strong> possible future ways of decid<strong>in</strong>g upon CRC treatment. Today stage III receivesadjuvant chemotherapy, most usually 5-FU <strong>in</strong> comb<strong>in</strong>ation with leucovor<strong>in</strong>, but other l<strong>in</strong>es of treatment exist.Some rectal tumors receive radiation therapy prior to surgery. Stage I <strong>and</strong> II are considered to be cured bysurgery alone <strong>and</strong> do <strong>no</strong>t receive additional treatment. Some stage II patients experience recurrence <strong>and</strong> wouldprobably benefit from adjuvant chemotherapy, whereas a subgroup of stage III <strong>in</strong>dividuals will be cured,regardless of chemotherapy. The problem lies <strong>in</strong> identify<strong>in</strong>g these <strong>in</strong>dividuals. The literature conta<strong>in</strong>s a largesuggestion of predictive <strong>and</strong> prog<strong>no</strong>stic markers but only CEA (carc<strong>in</strong>oembryonic antigen) has beenimplemented <strong>in</strong> the cl<strong>in</strong>ics. However, some of the suggested markers are close to be recommended for cl<strong>in</strong>icalpractice as they only lack well designed prospective studies verify<strong>in</strong>g their value as markers[130]. Some of theseare <strong>in</strong>cluded <strong>in</strong> the figure, such as MSI <strong>and</strong> ploidy. By identify<strong>in</strong>g the stage II patients with a poor prog<strong>no</strong>sis itwill be possible to improve prog<strong>no</strong>sis by offer<strong>in</strong>g adjuvant chemotherapy.36
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