Abstract
Colorectal carcinoma (CRC), although primarily a disease of adulthood, accounts for 2% of malignancies in adolescents and has been reported in children as young as 9 months of age. Our knowledge of CRC in pediatrics is based on a handful of case series and case reports. Apart from one small clinical trial, there has been a lack of prospective clinical studies in this age group. Based on these published reports, most CRC in children is sporadic, but it can also arise in the setting of predisposing conditions, such as gastrointestinal polyposis syndromes, nonpolyposis familial cancer syndromes, and inflammatory bowel disease. Despite some similarities to adult disease, CRC in childhood may be intrinsically different biologically, because it differs from adult-onset CRC in several respects. Childhood CRC tends to be diagnosed at an advanced stage, is largely of mucinous histology, and (probably because of these features) tends to have a poorer outcome. As a result of its rarity in children and the lack of prospective pediatric studies, recommendations for therapy are primarily extrapolated from adult clinical trials. A review of pediatric case series in the English literature emphasizes the prognostic significance of stage of disease, as well as extent of surgical resection. As in adults, early detection is critical in an effort to capture the disease at less advanced stages. Complete surgical resection with aggressive lymph node dissection is essential for cure, and neoadjuvant chemotherapy may be used in an effort to render unresectable lesions resectable. Active agents in adults with CRC include fluorouracil, folinic acid (leucovorin), oxaliplatin, and irinotecan. Furthermore, newer targeted therapeutic agents, such as bevacizumab and cetuximab, have added additional efficacy to the standard chemotherapy backbone. Collaborative multi-institutional pediatric clinical trials are needed to evaluate the prognosis, optimal treatment response, and the basic biology of childhood onset CRC.
Similar content being viewed by others
References
Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. Philadelphia (PA): Lippincott Williams & Wilkins, 2006
Ries LA, Wingo PA, Miller DS, et al. The annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer. Cancer 2000; 88: 2398–424
Fairley TL, Cardinez CJ, Martin J, et al. Colorectal cancer in U.S. adults younger than 50 years of age, 1998–2001. Cancer 2006; 107: 1153–61
Bleyer A, O’Leary M, Barr R, et al., editors. Cancer epidemiology in older adolescents and young adults 15–29 years of age, including SEER incidence and survival: 1975–2000. Bethesda (MD): National Cancer Institute, 2006: NIH pub. no: 06-5767
Hill DA, Furman WL, Billups CA, et al. Colorectal carcinoma in childhood and adolescence: a clinicopathologic review of 77 cases. J Clin Oncol 1007; 25(36): 5808–14
Andersson A, Bergdahl L. Carcinoma of the colon in children: a report of six new cases and a review of the literature. J Pediatr Surg 1976; 11: 967–71
Middelkamp JN, Haffner H. Carcinoma of the colon in children. Pediatrics 1963; 32: 558–71
Taguchi T, Suita S, Hirata Y, et al. Carcinoma of the colon in children: a case report and review of 41 Japanese cases. J Pediatr Gastroenterol Nutr 1991; 12: 394–9
Ferrari A, Rognone A, Casanova M, et al. Colorectal carcinoma in children and adolescents: the experience of the Istituto Nazionale Tumori of Milan, Italy. Pediatr Blood Cancer 2007; 50(3): 588–93
Goldthorn JF, Powars D, Hays DM. Adenocarcinoma of the colon and rectum in the adolescent. Surgery 1983; 93: 409–14
Lamego CM, Torloni H. Colorectal adenocarcinoma in childhood and adolescent: report of 11 cases and review of the literature. Pediatr Radiol 1989; 19: 504–8
Brown RA, Rode H, Millar AJ, et al. Colorectal carcinoma in children. J Pediatr Surg 1992; 27: 919–21
Shahrudin MD, Noori SM. Cancer of the colon and rectum in the first three decades of life. Hepatogastroenterology 1997; 44: 441–4
Karnak I, Ciftci AO, Senocak ME, et al. Colorectal carcinoma in children. J Pediatr Surg 1999; 34: 1499–504
Bhatia MS, Chandna S, Shah R, et al. Colorectal carcinoma in Indian children. Indian Pediatr 2000; 37: 1353–8
Vastyan AM, Walker J, Pinter AB, et al. Colorectal carcinoma in children and adolescents: a report of seven cases. Eur J Pediatr Surg 2001; 11: 338–41
Durno C, Aronson M, Bapat B, et al. Family history and molecular features of children, adolescents, and young adults with colorectal carcinoma. Gut 2005; 54: 1146–50
Chantada GL, Perelli VB, Lombardi MG, et al. Colorectal carcinoma in children, adolescents, and young adults. J Pediatr Hematol Oncol 2005; 27: 39–41
Sessions RT, Riddell DH, Kaplan HJ, et al. Carcinoma of the colon in the first two decades of life. Ann Surg 1965; 162: 279–84
LaQuaglia MP, Heller G, Filippa DA, et al. Prognostic factors and outcome in patients 21 years and under with colorectal carcinoma. J Pediatr Surg 1992; 27: 1085–9
Radhakrishnan CN, Bruce J. Colorectal cancers in children without any predisposing factors. A report of eight cases and review of the literature. Eur J Pediatr Surg 2003; 13: 66–8
Lewis CT, Riley WE, Georgeson K, et al. Carcinoma of the colon and rectum in patients less than 20 years of age. South Med J 1990; 83: 383–5
McGahren III ED, Mills SE, Wilhelm MC, et al. Colorectal carcinoma in patients 30 years of age and younger. Am Surg 1995; 61: 78–82
Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990; 61: 759–67
Morson BC. Genesis of colorectal cancer. Clin Gastroenterol 1976; 5: 505–25
Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988; 319: 525–32
Baker SJ, Preisinger AC, Jessup JM, et al. p53 gene mutations occur in combination with 17p allelic deletions as late events in colorectal tumorigenesis. Cancer Res 1990; 50: 7717–22
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977–81
Winawer SJ, Zauber AG, O’Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med 1993; 328: 901–6
Kern WH, White WC. Adenocarcinoma of the colon in a 9-month-old infant; report of a case. Cancer 1958; 11: 855–7
Chabalko JJ, Fraumeni Jr JF. Colorectal cancer in children: epidemiologic aspects. Dis Colon Rectum 1975; 18: 1–3
Ahsan H, Neugut AI, Garbowski GC, et al. Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med 1998; 128: 900–5
Bonelli L, Martines H, Conio M, et al. Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel: a case-control study. Int J Cancer 1988; 41: 513–7
Erdman SH, Barnard JA. Gastrointestinal polyps and polyposis syndromes in children. Curr Opin Pediatr 2002; 14: 576–82
Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 2000; 119: 1447–53
Chow E, Macrae F. A review of juvenile polyposis syndrome. J Gastroenterol Hepatol 2005 Nov; 20(11): 1634–40
Coburn MC, Pricolo VE, DeLuca FG, et al. Malignant potential in intestinal juvenile polyposis syndromes. Ann Surg Oncol 1995; 2: 386–91
Jass JR, Williams CB, Bussey HJ, et al. Juvenile polyposis: a precancerous condition. Histopathology 1988; 13: 619–30
Grady WM. Genetic testing for high-risk colon cancer patients. Gastroenterology 2003; 124: 1574–94
Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell 1996; 87: 159–70
Rowley PT. Inherited susceptibility to colorectal cancer. Annu Rev Med 2005; 56: 539–54
Distante S, Nasioulas S, Somers GR, et al. Familial adenomatous polyposis in a 5 year old child: a clinical, pathological, and molecular genetic study. J Med Genet 1996; 33: 157–60
Burt RW. Colon cancer screening. Gastroenterology 2000; 119: 837–53
Giardiello FM, Brensinger JD, Petersen GM. AGA technical review on hereditary colorectal cancer and genetic testing. Gastroenterology 2001; 121: 198–213
Church JM, McGannon E, Burke C, et al. Teenagers with familial adenomatous polyposis: what is their risk for colorectal cancer? Dis Colon Rectum 2002; 45: 887–9
Schlemmer M. Desmoid tumors and deep fibromatoses. Hematol Oncol Clin North Am 2005; 19: 565–71
Hamilton SR, Liu B, Parsons RE, et al. The molecular basis of Turcot’ s syndrome. N Engl J Med 1995; 332: 839–47
Lynch PM, Lynch HT, Harris RE. Hereditary proximal colonic cancer. Dis Colon Rectum 1977; 20: 661–8
Corredor J, Wambach J, Barnard J. Gastrointestinal polyps in children: advances in molecular genetics, diagnosis, and management. J Pediatr 2001; 138: 621–8
Peltomaki P, Vasen HF. Mutations predisposing to hereditary nonpolyposis colorectal cancer: database and results of a collaborative study. The International Collaborative Group on Hereditary Nonpolyposis Colorectal Cancer. Gastroenterology 1997; 113: 1146–58
Vasen HF, Watson P, Mecklin JP, et al. New clinical criteria for hereditary nonpolyposis colorectal cancer (HNPCC, Lynch syndrome) proposed by the International Collaborative group on HNPCC. Gastroenterology 1999; 116: 1453–6
Chung DC, Rustgi AK. The hereditary nonpolyposis colorectal cancer syndrome: genetics and clinical implications. Ann Intern Med 2003; 138: 560–70
Jo WS, Chung DC. Genetics of hereditary colorectal cancer. Semin Oncol 2005; 32: 11–23
Loftus Jr EV. Epidemiology and risk factors for colorectal dysplasia and cancer in ulcerative colitis. Gastroenterol Clin North Am 2006; 35: 517–31
Greenstein AJ, Slater G, Heimann TM, et al. A comparison of multiple synchronous colorectal cancer in ulcerative colitis, familial polyposis coli, and de novo cancer. Ann Surg 1986; 203: 123–8
Lashner BA, Turner BC, Bostwick DG, et al. Dysplasia and cancer complicating strictures in ulcerative colitis. Dig Dis Sci 1990; 35: 349–52
Holowach J, Thurston DL. Chronic ulcerative colitis in childhood. J Pediatr 1956; 48: 279–91
Jackman RJ, Bargen JA, Helmholz HF. Life histories of ninety-five children with chronic ulcerative colitis. Am J Dis Chil 1940; 59: 459–67
Wilcox Jr HR, Beattie JL. Carcinoma complicating ulcerative colitis during childhood. Am J Clin Pathol 1956; 26: 778–86
Hamilton SR. Colorectal carcinoma in patients with Crohn’s disease. Gastroenterology 1985; 89: 398–407
Tiszlavicz L, Kapin M, Varkonyi A, et al. Adenocarcinoma of the colon developing on the basis of Crohn’s disease in childhood. Eur J Pediatr 2001; 160: 168–72
Children’s Oncology Group Survivorship Guidelines [online]. Available from URL: http://www.survivorshipguidelines.org [Accessed 2007 Sep 15]
St John DJ, McDermott FT, Hopper JL, et al. Cancer risk in relatives of patients with common colorectal cancer. Ann Intern Med 1993; 118: 785–90
Fuchs CS, Giovannucci EL, Colditz GA, et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994; 331: 1669–74
Hall NR, Finan PJ, Ward B, et al. Genetic susceptibility to colorectal cancer in patients under 45 years of age. Br J Surg 1994; 81: 1485–9
Bhatia S, Pratt CB, Sharp GB, et al. Family history of cancer in children and young adults with colorectal cancer. Med Pediatr Oncol 1999; 33: 470–5
Datta RV, LaQuaglia MP, Paty PB. Genetic and phenotypic correlates of colorectal cancer in young patients. N Engl J Med 2000; 342: 137–8
Anfeld F. Casuitik der congenitalen neoplasm. Arch Gynaekol 1980; 16: 135–7
Lee YM, Law WL, Chu KW, et al. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192: 719–25
Symonds DA, Vickery AL. Mucinous carcinoma of the colon and rectum. Cancer 1976; 37: 1891–900
Consorti F, Lorenzotti A, Midiri G, et al. Prognostic significance of mucinous carcinoma of colon and rectum: a prospective case-control study. J Surg Oncol 2000; 73: 70–4
Anthony T, George R, Rodriguez-Bigas M, et al. Primary signet-ring cell carcinoma of the colon and rectum. Ann Surg Oncol 1996; 3: 344–8
Negri FV, Wotherspoon A, Cunningham D, et al. Mucinous histology predicts for reduced fluorouracil responsiveness and survival in advanced colorectal cancer. Ann Oncol 2005; 16: 1305–10
Green JB, Timmcke AE, Mitchell WT, et al. Mucinous carcinoma: just another colon cancer? Dis Colon Rectum 1993; 36: 49–54
Greene FL, Page DL, Fleming ID, et al., editors. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag, 2002
Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin 2004; 54: 295–308
Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124: 979–94
Sobin LH, Greene FL. TNM classification: clarification of number of regional lymph nodes for pNo [communication]. Cancer 2001; 92: 452
Rao BN, Pratt CB, Fleming ID, et al. Colon carcinoma in children and adolescents: a review of 30 cases. Cancer 1985; 55: 1322–6
Park IJ, Kim HC, Yu CS, et al. Efficacy of PET/CT in the accurate evaluation of primary colorectal carcinoma. Eur J Surg Oncol 2006; 32: 941–7
Delbeke D, Martin WH. PET and PET-CT for evaluation of colorectal carcinoma. Semin Nucl Med 2004; 34: 209–23
Cohade C, Osman M, Leal J, et al. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003; 44: 1797–803
Berger KL, Nicholson SA, Dehdashti F, et al. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 2000; 174: 1005–8
Pratt CB, Rao BN, Merchant TE, et al. Treatment of colorectal carcinoma in adolescents and young adults with surgery, 5-fluorouracil/leucovorin/inter-feron-alpha 2a and radiation therapy. Med Pediatr Oncol 1999; 32: 459–60
Markowitz AJ, Winawer SJ. Management of colorectal polyps. CA Cancer J Clin 1997; 47: 93–112
National comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: colon cancer [online]. Available from URL: http://www.nccn.org [Accessed 2007 Sep 15 ]
Sarli L, Bader G, Iusco D, et al. Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 2005; 41: 272–9
Swanson RS, Compton CC, Stewart AK, et al. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 2003; 10: 65–71
Andre T, Sargent D, Tabernero J, et al. Current issues in adjuvant treatment of stage II colon cancer. Ann Surg Oncol 2006; 13: 887–98
Berger AC, Sigurdson ER, Le Voyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 2005; 23: 8706–12
Newland RC, Dent OF, Lyttle MN, et al. Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients. Cancer 1994; 73: 2076–82
Chapuis PH, Dent OF, Bokey EL, et al. Adverse histopathological findings as a guide to patient management after curative resection of node-positive colonic cancer. Br J Surg 2004; 91: 349–54
Wiese DA, Saha S, Badin J, et al. Pathologic evaluation of sentinel lymph nodes in colorectal carcinoma. Arch Pathol Lab Med 2000; 124: 1759–63
Bertagnolli M, Miedema B, Redston M, et al. Sentinel node staging of resectable colon cancer: results of a multicenter study. Ann Surg 2004; 240: 624–8
Oberg A, Stenling R, Tavelin B, et al. Are lymph node micrometastases of any clinical significance in Dukes Stages A and B colorectal cancer? Dis Colon Rectum 1998; 41: 1244–9
Turner RR, Nora DT, Trocha SD, et al. Colorectal carcinoma nodal staging. Frequency and nature of cytokeratin-positive cells in sentinel and nonsentinel lymph nodes. Arch Pathol Lab Med 2003; 127: 673–9
Saha S, Dan AG, Beutler T, et al. Sentinel lymph node mapping technique in colon cancer. Semin Oncol 2004; 31: 374–81
Cooper HS, Deppisch LM, Gourley WK, et al. Endoscopically removed malignant colorectal polyps: clinicopathologic correlations. Gastroenterology 1995; 108: 1657–65
Cohen AM. Surgical considerations in patients with cancer of the colon and rectum. Semin Oncol 1991; 18: 381–7
Haggitt RC, Glotzbach RE, Soffer EE, et al. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328–36
Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 2004; 22: 1797–806
Benson III AB, Schrag D, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 2004; 22: 3408–19
Waterston AM, Cassidy J. Adjuvant treatment strategies for early colon cancer. Drugs 2005; 65: 1935–47
Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004; 351: 337–45
Kabbinavar F, Hurwitz HI, Fehrenbacher L, et al. Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol 2003; 21: 60–5
Hurwitz H, Fehrenbacher L, Novotny W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004; 350: 2335–42
Kabbinavar FF, Hambleton J, Mass RD, et al. Combined analysis of efficacy: the addition of bevacizumab to fluorouracil/leucovorin improves survival for patients with metastatic colorectal cancer. J Clin Oncol 2005; 23: 3706–12
Goldberg RM, Sargent DJ, Morton RF, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 2004; 22: 23–30
Colucci G, Gebbia V, Paoletti G, et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 2005; 23(22): 4866–75
Grothey A. Is there a third-line therapy for metastatic colorectal cancer? Semin Oncol 2006 Dec; 33 (6 Suppl. 11): S36–8
Saltz LB, Cox JV, Blanke C, et al. Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 2000; 343: 905–14
O’Connell MJ, Mailliard JA, Kahn MJ, et al. Controlled trial of fluorouracil and low-dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer. J Clin Oncol 1997; 15: 246–50
Wolmark N, Rockette H, Mamounas E, et al. Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluorouracil and levamisole, and fluoro-uracil, leucovorin, and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project C-04. J Clin Oncol 1999; 17: 3553–9
Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 2005; 352: 2696–704
Andre T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004; 350: 2343–51
Cheeseman SL, Joel SP, Chester JD, et al. A modified de Gramont regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer. Br J Cancer 2002; 87: 393–9
Haller DG, Catalano PJ, Macdonald JS, et al. Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J Clin Oncol 2005; 23: 8671–8
de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 2000; 18: 2938–47
International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 1995; 345: 939–44
Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997; 15: 938–46
Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818–25
McAfee MK, Allen MS, Trastek VF, et al. Colorectal lung metastases: results of surgical excision. Ann Thorac Surg 1992; 53: 780–5
Inoue M, Kotake Y, Nakagawa K, et al. Surgery for pulmonary metastases from colorectal carcinoma. Ann Thorac Surg 2000; 70: 380–3
Sakamoto T, Tsubota N, Iwanaga K, et al. Pulmonary resection for metastases from colorectal cancer. Chest 2001; 119: 1069–72
Pozzo C, Basso M, Cassano A, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol 2004; 15: 933–9
Delaunoit T, Alberts SR, Sargent DJ, et al. Chemotherapy permits resection of metastatic colorectal cancer: experience from Intergroup N9741. Ann Oncol 2005; 16: 425–9
Leonard GD, Brenner B, Kemeny NE. Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol 2005; 23: 2038–48
Kelly H, Goldberg RM. Systemic therapy for metastatic colorectal cancer: current options, current evidence. J Clin Oncol 2005; 23: 4553–60
Van CE, Twelves C, Cassidy J, et al. Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol 2001; 19: 4097–106
Hochster H, Kettner E, Kroning H, et al. Phase I/II dose-escalation study of pemetrexed plus irinotecan in patients with advanced colorectal cancer. Clin Colorectal Cancer 2005; 5: 257–62
Douillard JY, Cunningham D, Roth AD, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 2000; 355: 1041–7
Hurwitz HI, Fehrenbacher L, Hainsworth JD, et al. Bevacizumab in combination with fluorouracil and leucovorin: an active regimen for first-line metastatic colorectal cancer. J Clin Oncol 2005; 23: 3502–8
Cassidy J, Tabernero J, Twelves C, et al. XELOX (capecitabine plus oxaliplatin): active first-line therapy for patients with metastatic colorectal cancer. J Clin Oncol 2004; 22: 2084–91
Bender JL, Adamson PC, Reid JM, et al. Phase I trial and pharmacokinetic study of bevacizumab in pediatric patients with refractory solid tumors: a children’s oncology group study. J Clin Oncol 2008; 26(3): 399–405
Grothey A, Sargent D, Goldberg RM, et al. Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol 2005; 23: 9441–2
Grothey A, Sargent D. Overall survival of patients with advanced colorectal cancer correlates with availability of fluorouracil, irinotecan, and oxaliplatin regardless of whether doublet or single-agent therapy is used first line. J Clin Oncol 2004; 22: 1209–14
Aparicio J, Fernandez-Martos C, Vincent JM, et al. FOLFOX alternated with FOLFIRI as first-line chemotherapy for metastatic colorectal cancer. Clin Colorectal Cancer 2005 Nov; 5(4): 263–7
Acknowledgments
This work was supported by a Cancer Center Support Grant (CA 21765), and the American Lebanese Syrian Associated Charities (ALSAC). The authors have no conflicts of interest that are directly relevant to the content of this review. The authors thank Dr Sue Kaste for providing clinical images and Dr Jesse Jenkins for providing pathology images.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Saab, R., Furman, W.L. Epidemiology and Management Options for Colorectal Cancer in Children. Pediatr-Drugs 10, 177–192 (2008). https://doi.org/10.2165/00148581-200810030-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00148581-200810030-00006