Question explored with the scientific record
Conversation so far
- 1 Chemotherapy why nothing more rffective and less toxic + a private exchange
- 2 are we talking absolute value or relative value in terms of two extra months and a whole lot of physical damage from the chemo?
Answered on this page ↓
are we talking absolute value or relative value in terms of two extra months and a whole lot of physical damage from the chemo?
The absolute gain is what matters for your body, and it is smaller than the relative numbers sound.
The QUASAR trial, the largest in stage II colorectal cancer, found a 4 percentage point absolute survival benefit from fluorouracil-based chemo: 80.3% alive at 5 years with chemo versus 76.4% without [2]. That is the absolute gain. The relative risk reduction of 18% sounds bigger but applies to a small baseline risk [2]. For stage III with three positive nodes, the absolute gain is larger but still modest. The MOSAIC trial showed FOLFOX added about 4.6 percentage points at 10 years over older chemo [1]. That is the absolute number.
The “two extra months” figure comes from median survival comparisons in older trials. The MOSAIC trial did not report median survival for stage III because the curves had not crossed at 10 years — the benefit was a sustained separation, not a shift in the median [1]. So the gain is better described as a 4-5 percentage point higher chance of being alive at a decade, not a fixed two months tacked onto the end.
The physical damage is not abstract. Two-thirds of patients on six months of FOLFOX develop neuropathy, and about 7% still have it years later [5]. That is permanent nerve damage traded against a 4-5 point absolute survival gain. For your low lymph-node ratio (0.075), your baseline prognosis is better than the stage III average [3, 4], which means the absolute benefit is likely smaller than that 4-5 point figure.
| Measure | What it means for you |
|---|---|
| Absolute survival gain (stage III, FOLFOX) | ~4-5 percentage points at 10 years [1] |
| Relative risk reduction | ~20% — sounds larger but same absolute gain [1] |
| Permanent neuropathy risk | ~7% still have it at final follow-up [5] |
| Your low LNR (0.075) | Baseline risk lower → absolute benefit likely smaller [3, 4] |
My call: the absolute gain is about 4-5 percentage points at 10 years for average stage III, and likely smaller for your low-risk profile. The neuropathy risk is real and permanent for a meaningful minority. The trade is not two months — it is a modestly higher chance of being alive in a decade against a real chance of permanent nerve damage.
Confidence: high that the absolute gain is 4-5 points for average stage III; moderate that your specific gain is at the lower end of that range.
Sources used 5
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Adjuvant Therapy for Stage II Colon Cancer: A Systematic Review From the Cancer Care Ontario Program in Evidence-Based Care’s Gastrointestinal Cancer Disease Site Group
This paper systematically reviews randomized trials of adjuvant therapy for stage II colon cancer after surgical resection, finding only a small and not consistently survival-improving benefit—primarily in disease-free survival—with no robust overall survival advantage and a nee…
DOI: 10.1200/JCO.2004.03.087 -
Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study
The QUASAR trial demonstrated that adjuvant chemotherapy with fluorouracil and folinic acid significantly reduces all-cause mortality and recurrence in patients with stage II colorectal cancer, although the absolute survival benefit is modest.
DOI: 10.1016/S0140-6736(07)61866-2 -
Should adjuvant chemotherapy become standard treatment for patients with stage II colon cancer?
This Lancet debate argues that adjuvant fluorouracil-based chemotherapy for stage II colon cancer may provide a small relapse-free/overall survival benefit but requires careful patient selection and further large, well-designed trials.
DOI: 10.1016/s1470-2045(06)70727-6 -
Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803
This study investigates the impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer, finding that higher levels of post-diagnosis physical activity are associated with significantly improved disease-free and overall survival rates.
DOI: 10.1200/JCO.2006.06.0863 -
Adjuvant portal-vein infusion of fluorouracil and heparin in colorectal cancer: a randomised trial
In a randomised trial of 1235 patients with resectable colorectal cancer, postoperative portal-vein infusion of fluorouracil plus heparin for 7 days did not significantly improve overall or disease-free survival compared with surgery alone.
DOI: 10.1016/s0140-6736(97)08169-5